Cartilage defects occur in approximately 12% of the population and can result in significant function impairment and reduction in quality of life. Evidence for the variety of surgical treatments available is inconclusive. This study aimed to compare the clinical outcomes of patients with symptomatic cartilage defects treated with matrix-induced autologous chondrocyte implantation (MACI or microfracture (MF). Included patients were >or= 18 and

BackgroundHyaluronic acid (HA), lubricin, and phospholipid species (PLs) contribute independently or together to the boundary lubrication of articular joints that is provided by synovial fluid (SF). Our study is the first reporting quantitative data about the molecular weight (MW) forms of HA, lubricin, and PLs in SF from cohorts of healthy donors, patients with early (eOA)- or late (lOA)-stage osteoarthritis (OA), and patients with active rheumatoid arthritis (RA).MethodsWe used human SF from unaffected controls, eOA, lOA, and RA. HA and lubricin levels were measured by enzyme-linked immunosorbent assay. PLs was quantified by electrospray ionization tandem mass spectrometry. Fatty acids (FAs) were analyzed by gas chromatography, coupled with mass spectrometry. The MW distribution of HA was determined by agarose gel electrophoresis.ResultsCompared with control SF, the concentrations of HA and lubricin were lower in OA and RA SF, whereas those of PLs were higher in OA and RA SF. Moreover, the MW distribution of HA shifted toward the lower ranges in OA and RA SF. We noted distinct alterations between cohorts in the relative distribution of PLs and the degree of FA saturation and chain lengths of FAs.ConclusionsThe levels, composition, and MW distribution of all currently known lubricants in SF—HA, lubricin, PLs—vary with joint disease and stage of OA. Our study is the first delivering a comprehensive view about all joint lubricants during health and widespread joint diseases. Thus, we provide the framework to develop new optimal compounded lubricants to reduce joint destruction.

Purpose The aim of this investigation was to study patientreported long-term clinical outcome, instrumental stablitity and prevalence of radiological osteoarthritis (OA) a minimum of ten years after isolated anterior cruciate ligament (ACL) reconstruction. Methods An average of 13.5 years after ACL reconstruction with bone-patellar tendon-bone (BTB) autograft, 73 patients were evaluated. Inclusion criteria consisted of an isolated ACL rupture and reconstruction with BPTB graft with no associated intra-articular lesions, in particular, cartilage alterations or meniscal lesions. Clinical assessment was performed using the International Knee Documentation Committee (IKDC) and Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. Degree of degenerative changes and prevalence of OA were determined using the Kellgren-Lawrence scale. Results Mean follow-up was 13.5 years. Mean age was 43.8 years. About 75% of patients were graded A or B according to the IKDC score. The Lysholm score was 90.2± 4.8. Radiological assessment reported degenerative changes of grade II OA in 54.2% of patients. Prevalence of grades III or IV OA was found in 20%. The incidence of OA was significantly correlated with stability and function at long-term follow-up. Conclusion Arthroscopic ACL reconstruction using BPTB autograft resulted in a high degree of patient satisfaction and good clinical results on long-term follow-up. A higher degree of OA developed in 20% of patients and was significantly correlated with increased anterior laxity at long-term follow-up.

BackgroundClosing-wedge high tibial osteotomy (HTO) is successful for the treatment of medial osteoarthritis with varus malalignment. Preoperative risk factors for HTO failure are still controversial. The aim of this study was to elucidate the outcome and assess the influence of risk factors on long term HTO survival.Methods199 patients were retrospectively studied with a mean follow-up period of 9.6 years after HTO. HTO failure was defined as the need for conversion to TKA. Survival was analyzed with the Kaplan-Meier method. Knee function was evaluated by the Hospital for Special Surgery (HSS) score. HTO-associated complications were also assessed. Univariate, multivariate, and logistic regression analysis were performed to evaluate the influence of age, gender, BMI, preoperative Kellgren-Lawrence osteoarthritis grade, and varus angle on HTO failure.Results39 complications were recorded. Thus far, 36 HTOs were converted to TKA. The survival of HTO was 84% after 9.6 years. Knee function was considered excellent or good in 64% of patients. A significant preoperative risk factor for HTO failure was osteoarthritis, Kellgren-Lawrence grade >2.ConclusionHTO provides good clinical results in long-term follow-up. Preoperative osteoarthritis Kellgren-Lawrence grade >2 is a significant predictive risk factor for HTO failure. Results of HTO may be improved by careful patient selection. Complications associated with HTO should not be underestimated.

Prospective case control study with no control group, Level III.

HAS is an effective and valid assessment scale for evaluating sports activities before and after knee replacement.

Purpose The aim of this study was to evaluate patientreported clinical outcome, instrumental stability and prevalence of radiological osteoarthritis (OA) based on a homogeneous patient sample after two years and on average ten years after isolated anterior cruciate ligament (ACL) reconstruction. Methods Primarily we performed ACL reconstruction using a four-strand semitendinosus tendon (ST) autograft in 112 patients. Two years after reconstruction 98 patients could be re-evaluated. Long-term clinical and functional follow-up assessment was then performed on 52 patients on average 10.2 years after operative treatment. Inclusion criteria consisted of an isolated ACL rupture, reconstruction with ST graft and no associated cartilage alterations and meniscal lesions. Clinical and functional follow-up assessment included the International Knee Documentation Committee (IKDC) score and the scores of Tegner and Lysholm. Instrumental stability testing was carried out with the KT1000™ arthrometer. The degree of degenerative changes and prevalence of OA was based on the Jäger-Wirth score. Results The mean long-term follow-up was 10.2 years (eight-13 years), and the mean age was 40.4 years (24-62 years). About 72 % of patients were graded A or B according to the IKDC score. Activity levels according to the scores of Tegner and Lysholm were 4.8 and 88.2 on long-term follow-up. Radiological assessment revealed degenerative changes in the sense of a grade I OA in 21.2 % of patients. Prevalence of a grade II OA was found in 53.8 % of patients. A grade III OA and a grade IV OA were found in 19.2 and 5.7 %. Correlation analysis showed significant relationships between the long-term stability and prevalence of OA (p<0.05). Conclusions Arthroscopic ACL reconstruction using fourstrand ST autograft resulted in high patient satisfaction and good clinical results at two years and long-term follow-up. The prevalence of higher degree OA that developed in about 25 % of patients is significantly correlated with long-term knee joint stability.

The Metha implant shows excellent osseointegration at the coated area of the stem without factors of aseptic loosening in the short term. This study shows that parameters like age, sex and BMI influence BMD progression and stress shielding. Metha implant shows excellent results especially in young patients with good bone stock.