Long-term outcome of grade III and IV chondral injuries of the knee treated with Steadman microfracture technique

Pellegrino, Marco; Trinchese, Ermanno; Bisaccia, Michele; Rinonapoli, Giuseppe; Meccariello, Luigi; Falzarano, Gabriele; Medici, Antonio; Piscitelli, Luigi; Ferrara, P.; Caraffa, Alessandro

doi:10.11138/ccmbm/2016.13.3.237

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…However, Boraiah et al found out that the incidence of heterotopic ossification was significantly higher in the BMP-positive patients than in the BMP-negative ones. Being given this, the use of BMP in periarticular fractures can lead to undesired reinterventions, so the caregivers should balance first the pearls and the pitfalls of these products before utilizing them [38,39].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients

Russu

Pop

Ciorcila

et al. 2021

JPM

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Background: The objective of the arthroscopic treatment in tibial spine avulsion fractures (TSAF) is to achieve firm reduction and strong internal fixation while still having the patient undergo a minimally invasive procedure. Material and methods: The study was performed on 12 young patients with avulsion fracture of the anterior tibial spine. All 12 patients had type 3 Modified Meyers and McKeever fractures. The injury mechanism was direct anterior to posterior trauma in full leg length hyperextension with sport trauma reported in all cases. The physical examination revealed decreased range of motion, extension deficit, and pain during walking. Radiology, MRI, and CT pathologic findings described complete fracture of the anterior tibial spine with no clear signs of callus formation at the time of examination. All patients underwent arthroscopic suture surgical treatment. The Tegner, the Lysholm, and the International Knee Documentation Committee (IKDC) scores were used to evaluate subjective outcomes at three and six months after the surgery. Radiographs were used to assess callus formation and healing status of the fracture. Results: The mean IKDC score was 33.4 ± 23.3 (p = 0.032) preoperatively and 84.2 ± 14.3 at final follow-up (p = 0.0032, CI = 95%). The mean Tegner score improved from 3.8 ± 1.1 pre-operatively to 6.7 ± 2.2 at six months follow-up (p = 0.0231, CI = 95%). The Lysholm score differed significantly at baseline compared to final follow-up (53.7 ± 17.3 vs. 87.7 ± 9.9; p = 0.0066, CI = 95%). In all cases (n = 12), the radiographs taken after six months revealed the healing of the fracture in the anatomic position without secondary displacement. No functional knee instability was detected at the end of the study. Conclusions: The study provides preliminary promising results regarding fracture healing, knee stability, and functional subjective scores. Patient selection was a major factor of success prediction for this technique.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients

Russu

Pop

Ciorcila

et al. 2021

JPM

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“…MFX remains the most common comparison group by which the investigative treatments are still measured in both the published and current clinical trials, likely because of its long track record over several decades, significant body of literature, ease of performance, and low cost. 54,55 This systematic review of the published studies and clinical trials is also helpful in demonstrating the patient demographic of interest for researchers looking to find benefit from cartilage repair/restoration efforts in the knee. Young to middle-aged adults, between 18 and 50 years of age, with normal or near-normal range BMI were the most common patient populations in these studies.…”

Section: Discussionmentioning

confidence: 99%

Wide Variation in Methodology in Level I and II Studies on Cartilage Repair: A Systematic Review of Available Clinical Trials Comparing Patient Demographics, Treatment Means, and Outcomes Reporting

et al. 2018

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Background The management of complex cartilage pathology in young, otherwise healthy patients can be difficult. Purpose To determine the nature of the design, endpoints chosen, and rate at which the endpoints were met in published studies and ongoing clinical trials that investigate cartilage repair and restoration procedures. Study Design Systematic review. Methods A systematic review of the publicly available level I/II literature and of the publicly listed clinical trials regarding cartilage repair and restoration procedures for the knee was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Seventeen published studies and 52 clinical trials were included. Within the 17 published studies, the most common procedure studied was microfracture (MFX) + augmentation ( N = 5; 29.4%) and the most common comparison/control group was MFX ( N = 10; 58.8%). In total, 13 different cartilage procedure groups were evaluated. For published studies, the most common patient-reported outcome (PRO) measures assessed is the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale–Pain (VAS) ( N = 10 studies, 58.8% each, respectively). Overall, there are 10 different PROs used among the included studies. Ten studies demonstrate superiority, 5 demonstrate noninferiority, and 2 demonstrate inferiority to the comparison or control groups. For the clinical trials included, the most common procedure studied is MFX + augmentation ( N = 16; 30.8%). The most common PRO assessed is KOOS ( N = 36 trials; 69.2%), and overall there are 24 different PROs used among the included studies. Conclusions Recently published studies and clinical trials evaluate a variety of cartilage repair and restoration strategies for the knee, most commonly MFX + augmentation, at various time points of outcome evaluation, with KOOS and VAS scores being used most commonly. MFX remains the most common comparison group for these therapeutic investigations. Most studies demonstrate superiority versus comparison or control groups. Understanding the nature of published and ongoing clinical trials will be helpful in the investigation of emerging technologies required to navigate the regulatory process while studying a relatively narrow population of patients.

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“…The microfracture and microdrilling techniques used to treat cartilage lesions create holes in the subchondral plate to release adjacent bone marrow, which initiates a healing response in osteochondral injury (268,269). These procedures have been shown to cause fibrocartilaginous healing that can provide a return to normal function in select patients (279). However, the cartilage produced is type I cartilage and not the original type II hyaline cartilage.…”

Section: Cartilagementioning

confidence: 99%

Bone Marrow Concentrate (BMC) Therapy in Musculoskeletal Disorders: Evidence-Based Policy Position Statement of American Society of Interventional Pain Physicians (ASIPP)

Centeno¹

2020

Pain Phys

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Background: The use of bone marrow concentrate (BMC) for treatment of musculoskeletal disorders has become increasingly popular over the last several years, as technology has improved along with the need for better solutions for these pathologies. The use of cellular tissue raises a number of issues regarding the US Food and Drug Administration’s (FDA) regulation in classifying these treatments as a drug versus just autologous tissue transplantation. In the case of BMC in musculoskeletal and spine care, this determination will likely hinge on whether BMC is homologous to the musculoskeletal system and spine. Objectives: The aim of this review is to describe the current regulatory guidelines set in place by the FDA, specifically the terminology around “minimal manipulation” and “homologous use” within Regulation 21 CFR Part 1271, and specifically how this applies to the use of BMC in interventional musculoskeletal medicine. Methods: The methodology utilized here is similar to the methodology utilized in preparation of multiple guidelines employing the experience of a panel of experts from various medical specialties and subspecialties from differing regions of the world. The collaborators who developed these position statements have submitted their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these position statements. The literature pertaining to BMC, its effectiveness, adverse consequences, FDA regulations, criteria for meeting the standards of minimal manipulation, and homologous use were comprehensively reviewed using a best evidence synthesis of the available and relevant literature. Results/Summary of Evidence: In conjunction with evidence-based medicine principles, the following position statements were developed: Statement 1: Based on a review of the literature in discussing the preparation of BMC using accepted methodologies, there is strong evidence of minimal manipulation in its preparation, and moderate evidence for homologous utility for various musculoskeletal and spinal conditions qualifies for the same surgical exemption. Background: The use of bone marrow concentrate (BMC) for treatment of musculoskeletal disorders has become increasingly popular over the last several years, as technology has improved along with the need for better solutions for these pathologies. The use of cellular tissue raises a number of issues regarding the US Food and Drug Administration’s (FDA) regulation in classifying these treatments as a drug versus just autologous tissue transplantation. In the case of BMC in musculoskeletal and spine care, this determination will likely hinge on whether BMC is homologous to the musculoskeletal system and spine. Objectives: The aim of this review is to describe the current regulatory guidelines set in place by the FDA, specifically the terminology around “minimal manipulation” and “homologous use” within Regulation 21 CFR Part 1271, and specifically how this applies to the use of BMC in interventional musculoskeletal medicine. Methods: The methodology utilized here is similar to the methodology utilized in preparation of multiple guidelines employing the experience of a panel of experts from various medical specialties and subspecialties from differing regions of the world. The collaborators who developed these position statements have submitted their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these position statements. The literature pertaining to BMC, its effectiveness, adverse consequences, FDA regulations, criteria for meeting the standards of minimal manipulation, and homologous use were comprehensively reviewed using a best evidence synthesis of the available and relevant literature. Results/Summary of Evidence: In conjunction with evidence-based medicine principles, the following position statements were developed: Statement 1: Based on a review of the literature in discussing the preparation of BMC using accepted methodologies, there is strong evidence of minimal manipulation in its preparation, and moderate evidence for homologous utility for various musculoskeletal and spinal conditions qualifies for the same surgical exemption.

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Long-term outcome of grade III and IV chondral injuries of the knee treated with Steadman microfracture technique

Cited by 10 publications

References 16 publications

Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients

Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients

Wide Variation in Methodology in Level I and II Studies on Cartilage Repair: A Systematic Review of Available Clinical Trials Comparing Patient Demographics, Treatment Means, and Outcomes Reporting

Bone Marrow Concentrate (BMC) Therapy in Musculoskeletal Disorders: Evidence-Based Policy Position Statement of American Society of Interventional Pain Physicians (ASIPP)

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