We aimed to evaluate whether and to what extent an isolated deep cartilage lesion localized within the tibiofemoral and the patellofemoral joint has an impact on the clinical outcomes and osteoarthritis (OA) progression when it is left untreated. From 1991 to 1994, 4121 consecutive knee arthroscopies were performed, and 37 of them in patients with a single isolated chondral lesion of Outerbridge grade 4 located within weight-bearing areas of the femoral and tibial condyles (FT group) and patella (P group). The lesion size ranged from 2 to 4 cm(2) . Outcomes were reported at a mean 15.3-year follow-up using the Lysholm score, the Tegner activity scale and the Womac score. The mean Lysholm, Tegner and Womac score in the FT group was 87.7, 5.6 and 88.7, respectively. In the P group, it was 83.8, 4.8 and 84.6, respectively (P<0.0.5). Osteoarthritic changes were found in 39% of the patients. There was no difference in OA severity between an injured and an uninjured knee. In patients of the FT group, there was a relationship between the incidence of tibiofemoral OA and patellofemoral OA (P=0.00075). Severe isolated single chondral damage left with no treatment has a limited influence on clinical outcomes and the development of OA.

Background: Osteoarthritis (OA) is considered a contraindication to most cartilage repair techniques. Several regenerative approaches have been attempted with the aim of delaying or preventing joint replacement, with controversial results. Currently, there is a paucity of data on the use of single-step techniques, such as cell-free biomimetic scaffolds, for the treatment of joint surface lesions (JSLs) in OA knees. Purpose: To present the 2-year follow-up clinical and radiological outcomes after implantation of a novel, cell-free aragonite-based scaffold for the treatment of JSLs in patients with mild to moderate knee OA in a multicenter prospective study. Study Design: Case series; Level of evidence, 4. Methods: A total of 86 patients, 60 male and 26 female, with a mean age of 37.4 ± 10.0 years, mild to moderate knee OA, and a mean defect size of 3.0 ± 1.7 cm2, were recruited at 8 medical centers according to the following criteria: radiographic mild to moderate knee OA (Kellgren-Lawrence grade 2 or 3); up to 3 treatable chondral/osteochondral defects (International Cartilage Repair Society grades 3 and 4) on the femoral condyles or trochlea; a total defect size ≤7 cm2; and no concurrent knee instability, severe axial malalignment, or systemic arthropathy. All patients were evaluated at baseline and at 6, 12, 18, and 24 months after implantation using the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective score. Additionally, magnetic resonance imaging (MRI) was performed to assess the amount of cartilage defect filling at the repaired site. Results: Significant improvement on all KOOS subscales was recorded from baseline (Pain: 49.6 ± 13.1; Activities of Daily Living [ADL]: 56.1 ± 18.4; Sport: 22.8 ± 18.8; Quality of Life [QoL]: 23.5 ± 16.5; Symptoms: 55.4 ± 19.9) to the 24 months’ follow-up (Pain: 79.5 ± 21.1 [ P < .001]; ADL: 84.1 ± 21.4 [ P < .001]; Sport: 60.8 ± 31.9 [ P < .001]; QoL: 54.9 ± 30.4 [ P < .001]; Symptoms: 77.7 ± 21.2 [ P < .001]). The IKDC subjective score showed a similar trend and improved from 37.8 ± 14.7 at baseline to 65.8 ± 23.5 at 24 months ( P < .001). MRI showed a significant increase in defect filling over time: up to 78.7% ± 25.3% of surface coverage after 24 months. Treatment failure requiring revision surgery occurred in 8 patients (9.3%). Conclusion: The use of an aragonite-based osteochondral scaffold in patients with JSLs and mild to moderate knee OA provided significant clinical improvement at the 24-month follow-up, as reported by the patients. These findings were associated with good cartilage defect filling, as observed on MRI.

Breaking the dilemma between small size and room-temperature stability is a necessary prerequisite for skyrmion-based information technology. Here we demonstrate by means of rate theory and an atomistic spin Hamiltonian that the stability of isolated skyrmions in ultrathin ferromagnetic films can be enhanced by the concerted variation of magnetic interactions while keeping the skyrmion size unchanged. We predict film systems where the lifetime of sub-10 nm skyrmions can reach years at ambient conditions. The long lifetime of such small skyrmions is due to exceptionally large Arrhenius pre-exponential factor and the stabilizing effect of the energy barrier is insignificant at room temperature. A dramatic increase in the pre-exponential factor is achieved thanks to the softening of magnon modes of the skyrmion, thereby increasing the entropy of the skyrmion with respect to the transition state for collapse. Increasing the number of skyrmion deformation modes should be a guiding principle for the realization of nanoscale, room-temperature stable skyrmions.

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