Clinical relevance of engineered cartilage maturation in a randomized multicenter trial for articular cartilage repair.

Cartilage lesions do not heal spontaneously and predispose to osteoarthritis. Functional cartilage tissues, engineered using autologous chondrocytes, have a therapeutic advantage over conventional cellular therapies in preclinical studies. Here, we tested whether ex vivo maturation of engineered grafts for cartilage repair leads to improved patient benefit.

Hand Dominance Is Not of Significance in Performing Fundamental Arthroscopic Skills Simulation Training Tasks.

Purpose: To compare the performance of the dominant and nondominant hand during fundamental arthroscopic simulator training.

Methods: Surgical trainees who participated in a 2-day simulator training course between 2021 and 2023 were classified, according to their arthroscopic experience in beginners and competents. Only right-handed individuals with complete data sets were included in the study.

Rotational alignment of the lower extremity in the presence of total knee endoprosthesis: Reproducibility of torsion analyses using ultra-low-dose photon-counting CT.

Purpose: Leg torsion analysis can provide valuable information in symptomatic patients after total knee arthroplasty. However, extensive beam-hardening and photon-starvation artifacts limit diagnostic assessability and dose reduction potential. For this study, we investigated the reproducibility of rotational measurements in ultra-low-dose photon-counting CT with spectral shaping via tin prefiltration.

The number of arthroscopies performed by trainees does not deduce the level of their arthroscopic proficiency.

Purpose: It is reasonable to question whether the case volume is a suitable proxy for the manual competence of an arthroscopic surgeon. The aim of this study was to evaluate the correlation between the number of arthroscopies previously performed and the arthroscopic skills acquired using a standardized simulator test.

Methods: A total of 97 resident and early orthopaedic surgeons who participated in arthroscopic simulator training courses were divided into five groups based on their self-reported number of arthroscopic surgeries: (1) none, (2) < 10, (3) 10 to 19, (4) 20 to 39 and (5) 40 to 100.

The AMADEUS score is not a sufficient predictor for functional outcome after high tibial osteotomy.

Purpose: The Area Measurement And Depth Underlying Structures (AMADEUS) classification system has been proposed as a valuable tool for magnetic resonance (MR)-based grading of preoperatively encountered chondral defects of the knee joint. However, the potential relationship of this novel score with clinical data was yet to determine. It was the primary intention of this study to assess the correlative relationship of the AMADEUS with patient reported outcome scores in patients undergoing medial open-wedge high tibial valgus osteotomy (HTO).

Can the MRI based AMADEUS score accurately assess pre-surgery chondral defect severity according to the ICRS arthroscopic classification system?

Purpose: The AMADEUS (Area Measurement And DEpth and Underlying Structures) scoring and grading system has been proposed for the MRI based evaluation of untreated focal chondral defects around the knee. The clinical practicability, its correlation with arthroscopically assessed grading systems (ICRS - International Cartilage Repair Society) and thereby its clinical value in terms of decision making and guiding prognosis was yet to determine.

Methods: From 2008 to 2019 a total of 89 individuals were indicated for high tibial valgus osteotomy (HTO) due to tibial varus deformity and concomitant chondral defects of the medial compartment of the knee.

The 3-triangle method preserves the posterior tibial slope during high tibial valgus osteotomy: first preliminary data using a mathematical model.

Purpose: Despite much improved preoperative planning techniques accurate intraoperative assessment of the high tibial valgus osteotomy (HTO) remains challenging and often results in coronal over- and under-corrections as well as unintended changes of the posterior tibial slope. Noyes et al. reported a novel method for accurate intraoperative coronal and sagittal alignment correction based on a three-dimensional mathematical model.

Focal cartilage defects of the lateral compartment do influence the outcome after high tibial valgus osteotomy.

Introduction: High tibial medial open-wedge valgus osteotomy (HTO) is a well-established procedure for unicompartimental medial osteoarthritis of the young and active patient. However, the influence of cartilage defects of the lateral compartment on the total outcome remains obscure.

Methods: From 2005 to 2012, a total of 63 patients underwent HTO for medial osteoarthritis of the knee at a single university orthopaedic center.

Ten hours of simulator training in arthroscopy are insufficient to reach the target level based on the Diagnostic Arthroscopic Skill Score.

Purpose: Simulator arthroscopy training has gained popularity in recent years. However, it remains unclear what level of competency surgeons may achieve in what time frame using virtual training. It was hypothesized that 10 h of training would be sufficient to reach the target level defined by experts based on the Diagnostic Arthroscopic Skill Score (DASS).

The Diagnostic Arthroscopy Skill Score (DASS): a reliable and suitable assessment tool for arthroscopic skill training.

Purpose: To develop and validate a novel score to more objectively assess the performance of diagnostic knee arthroscopy using a simulator.

Methods: A Diagnostic Arthroscopy Skill Score (DASS) was developed by ten AGA (AGA-Society for Arthroscopy and Joint-Surgery) instructors for the assessment of arthroscopic skills. DASS consists of two parts: the evaluation of standardized diagnostic knee arthroscopy (DASS) and the evaluation of manual dexterity, including ambidexterity and triangulation, using objective measurement parameters (DASS).

Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation.

Purpose: This study investigates the redislocation rate and functional outcome at a minimum follow-up of five years after medial patellofemoral ligament (MPFL) reconstruction with soft tissue patellar fixation for patella instability.

Methods: Patients were retrospectively identified and knees were evaluated for trochlea dysplasia according to Dejour, for presence of patella alta and for presence of cartilage lesion at surgery. At a minimum follow-up of five years, information about an incident of redislocation was obtained.

Is debridement beneficial for focal cartilage defects of the knee: data from the German Cartilage Registry (KnorpelRegister DGOU).

Introduction: Focal cartilage defects of the knee are often treated with arthroscopic debridement. Existing literature discussing the benefit of debridement for small articular cartilage lesions is scarce, especially if the debridement was not part of a combined operative cartilage procedure including meniscal and ligament repair. The purpose of this study was to examine the patients´ benefit after arthroscopic debridement for the treatment of isolated focal chondral defects with or without partial meniscus resection.

[Virtual arthroscopy : Gaming or training concept of the future].

Arthroscopy is a technically challenging surgical procedure with a relatively shallow learning curve compared to open procedures. To become an expert special cognitive and manual abilities have to be acquired and trained. The current situation in further medical education combined with the increasing economic pressure in the medical field does not leave enough room for a time-consuming training in arthroscopic techniques.

[Update of the German S3 guideline on atraumatic femoral head necrosis in adults].

The update of the German S3 guideline on atraumatic femoral head necrosis in adults aims to provide an overview of diagnosis and treatment. All clinical studies, systematic reviews, and meta-analyses published in German or English between 01.05.

Long-term outcome of anterior cruciate ligament tear without reconstruction: a longitudinal prospective study.

Purpose: To analyse subjective and objective long-term outcomes of patients with anterior cruciate ligament (ACL)-deficient knees and limited demands regarding sportive activities. This subgroup of patients might be well-treated without ligament reconstruction.

Methods: We included 303 patients with unilateral tears of the ACL and conservative treatment into a prospective study.

Tissue engineering and regenerative medicine in musculoskeletal oncology.

Currently used surgical techniques to reconstruct tissue defects after resection of musculoskeletal tumours are associated with high complication rates. This drives a strong demand for innovative therapeutic concepts that are able to improve the clinical outcomes of patients suffering from bone and soft tissue tumours. Tissue engineering and regenerative medicine (TE&RM) provides a technology platform based on biochemical, molecular, cellular and biomaterials modules to selectively direct tissue healing processes for improved defect regeneration.

Nail-patella-syndrome in a young patient followed up over 10 years: relevance of the sagittal trochlear septum for patellofemoral pathology.

Introduction: Nail-patella-syndrome (NPS) is a rare autosomal-dominant inherited disease with pathologies of nails, skeleton, kidneys, and eyes. Linkage to a mutated gene was found. It codes for the transcription-factor LMX1B.

No significant difference in clinical outcome and knee stability between patellar tendon and semitendinosus tendon in anterior cruciate ligament reconstruction.

Introduction: ACL reconstruction with either patellar tendon or semitendinosus tendon autografts are standard procedures. Between these two grafts might be differences in stability, morbidity, or long-term changes. This study investigates outcomes of ACL reconstruction with patellar tendon versus semitendinosus tendon autografts.

S3-Guideline non-traumatic adult femoral head necrosis.

Introduction: The treatment of adult non-traumatic avascular necrosis of the femoral head (AVN; N-ANFH) within an estimated incidence of 5000-7000 cases per annum in Germany remains a challenge. Risk factors include steroids, alcohol abuse, chemotherapy and immunosuppressive medication, but a genetic predisposition has been suggested. Early diagnosis of this often bilateral disease process is essential for successful conservative or joint preserving surgical management.

[Gracilis tendon augmented reconstruction of the medial patellofemoral ligament with soft tissue fixation at the patellar insertion site].

Objective: Reconstruction of the medial patellofemoral ligament with autologous tendon augmentation and soft tissue fixation at the patellar insertion with resorbable suture material.

Indications: Patellofemoral instability due to insufficiency of the medial passive stabilizers and dysplastic trochlea.

Contraindications: Primary traumatic dislocation of the patella without risk factors for patellar redislocation, severe osteoarthritis of the patellofemoral joint, infection.