Purpose The purpose of the present study was to investigate the mid‐term outcomes of a single‐stage cell‐based procedure in patients with knee focal symptomatic cartilage defects using matrix‐induced culture‐expanded autologous AD‐MSCs. It was hypothesised that the increased number of autologous AD‐MSCs after culture expansion is a safe and efficient cartilage repair procedure, which improves overtime chondrogenesis in cartilage lesions Methods Twenty‐five consecutive patients treated for a symptomatic cartilage defect were prospectively followed for 3 years. The median age of patients was 30.5 (range 16–43) with a median BMI of 23.6 kg/m2 (range 19–29) and an average size of the lesion of 3.5 cm2 (range 2–6). All patients underwent a single‐stage procedure consisting in filling each defect with autologous culture‐expanded mesenchymal stem cells embedded in a trimmed‐to‐fit commercially available biodegradable matrix. Pre‐operative and post‐operative evaluation included knee‐related clinical and functional evaluation based on objective and subjective scores at 6, 12, 24 and 36 months and MRI evaluation of the repair tissue using the MOCART score at 12 and 24 months. Results Clinical outcomes recorded significant improvements (p < 0.05) at the final follow‐up compared with baseline as following: all subcategories of KOOS Score, the IKDC subjective from 40.9 (range 20.7–65.6) to 76.9 (range 42–90.3), Tegner Activity Score from 3 (range 2–4) to 4 (range 3–4), VAS for pain from 6 (range 4–8) to 1 (range 0–3). All patients improve significantly their IKDC objective scores. The MRI findings showed complete filling of the defect and integration to the border zone for 65% of the patients. Two patients underwent post‐operative biopsies and the histological analysis demonstrated the presence of hyaline‐like tissue. Conclusions Adipose‐derived culture‐expanded mesenchymal stem cells were shown to be an efficient and safe single‐stage cell‐based procedure for symptomatic, full‐thickness knee chondral lesions. The findings of the present study demonstrate that all patients presented significant mid‐term clinical, functional and radiological improvement. Level of evidence IV.

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PurposeThe purpose of the present study was to systematically review the clinical and functional outcomes following medial unicompartmental knee arthroplasty (UKA) in patients under the age of 60 years old. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies between 2012 and April 2022, on patients 18-60 years old who have had a unicompartmental knee replacement evaluating patient-reported outcomes measures (PROMs), were included. The Knee Society Scores (KSS) clinical score was considered the primary outcome. Pre-and post-operative range of motion (ROM), PROMs, complications and survival were recorded. Paired sample t testing was performed to compare the pre-operative with post-operative KSS. Results Seventeen articles comprising 2083 unicompartmental arthroplasties were included. The follow-up range was between 1 and 15 years. In eligible studies, all reported outcomes were improved following UKA. The mean KSS clinical was signiicantly improved from 45.5 (SD: 9.6) pre-operatively to 89.4 (SD: 4.4) post-operatively (p = 0.0001). Mean implant survival ranged 86-96.5% at 10 years follow-up. There was no signiicant diference between mobile and ixed bearing in terms of ROM and KSS clinical. In total, 92 revisions and 7 re-operations with implant retention were reported. Conclusion Unicompartmental knee arthroplasty for medial osteoarthritis is a safe, reliable and efective treatment option for patients of 60 years or younger. It provides pain relief, satisfactory activity level, excellent clinical outcomes, and up to 96.5% implant survival at 10-year follow-up. Level of evidence IV.

Objective To prospectively assess the early changes in the quadriceps and patellar tendons before and after total knee arthroplasty using ultrasound, shear wave elastography, and X-rays. Materials and methods Radiographs, ultrasound, and shear wave elastography were performed on 23 patients (16 women; aged 51-85, mean 66 ± 9 years) before and after surgery at 6 weeks and on 11 patients at 3 months. Patellar position and patellar tendon lengths were evaluated by radiography; joint effusion or synovitis, quadriceps and patellar tendon lengths, and thicknesses, echogenicity, vascularity, and stiffness were assessed with ultrasound and shear wave elastography. Results In the early postoperative period, 87% of the patients had joint effusion, and 43% had signs of synovitis. There was a significant thickening of the quadriceps tendon in 51.5% (p < .0001) and of the patellar tendon in 93.8% (p < .0001) of patients with a significant shortening of the patellar tendon in 7.8% (p < .0001). A hypoechoic defect on the medial aspect of the quadriceps tendon was found in 87% of the patients. There was a significant increase in Young's modulus in the quadriceps tendon (p = .0006) but not in the patellar tendon. Conclusion The following should not be considered to be pathological findings at early postoperative imaging: joint effusion, synovitis, increasing of stiffness and thickening of quadriceps tendons by more than 50%, thickening of patellar tendon by more than 90%, focal defect through the medial aspect of the quadriceps tendon, and shortening of the patellar tendon by 8%.