The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.
Magnetic resonance imaging (MRI) is the gold standard method for non-invasive assessment of joint cartilage, providing information on the structure, morphology and molecular composition of this tissue. There are certain minimum requirements for a MRI study of cartilage tissue: machines with a high magnetic field (> 1.5 Tesla); the use of surface coils; and the use of T2-weighted, proton density-weighted fast-spin echo (T2 FSE-DP) and 3D fat-suppressed T1-weighted gradient echo (3D-FS T1W GRE) sequences. For better contrast between the different joint structures, MR arthography is a method that can highlight minimal fibrillation or fractures of the articular surface and allow evaluation of the integrity of the native cartilagerepair tissue interface. To assess the biochemical composition of cartilage and cartilage repair tissue, various techniques have been proposed for studying proteoglycans [dGEMRIC, T1rho mapping, sodium (23Na) imaging MRI, etc.], collagen, and water distribution [T2 mapping, "magnetisation transfer contrast", diffusion-weighted imaging (DWI), and so on]. Several MRI classifications have been proposed for evaluating the processes of joint degeneration (WORMS, BLOKS, ICRS) and post-surgical maturation of repair tissue (MOCART, 3D MOCART). In the future, isotropic 3D sequences set to improve image quality and facilitate the diagnosis of disorders of articular structures adjacent to cartilage.
Purpose: the unstable osteochondritis dissecans (oCD-type ii and iii according to the iCRs classification) of the knee largher than > 2.5 cm 2 in adults are uncommon lesions and there is no consensus on how to treat them. Medium-term studies have reported good re sults using autogenous osteochondral plugs (mosaicplasty). the aim of this study is to analyze the long-term results of this technique for the treatment of unstable oCD in a selected group of adult patients. Methods: four patients with oCD at either one of the femoral condyles were included in this prospective study. the average age was 21.2 years (range, 18-24 years). the oCD lesions were classified as type ii in three patients and type iii in one patient and the average size was 3.8 cm 2 (range, 2.55-5.1 cm 2 ). the lesions were treated in situ with a variable number of autogenous osteochondral plugs (Ø 4.5 mm 2 ). the Modified Cincinnati, Lysholm ii and tegner scores were used for clinical and functional evaluation. Magnetic resonance arthrography (MRA) was performed before surgery and at 2, 5 and 10 years after surgery. A modified MoCARt score was used to evaluate MRA findings.Results: the average follow-up duration was ten years and 6 months (range, 10-11 years). no complications occurred. At the final follow-up, all scores (clinical, functional and MoCARt) improved. in all but one of the patients MRA showed complete osteochondral repair. Conclusions: the fixation of large and unstable oCD lesions with mosaicplasty may be a good option for treating type ii or iii oCD lesions in adults. the advantages of this technique include stable fixation, promotion of blood supply to the base of the oCD fragment, and grafting of autologous cancellous bone that stimulates healing with preservation of the articular surface. Level of evidence: Level iV, therapeutic case series.
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