Arthroscopic Osteochondral Autograft Transfer System Procedure of the Lateral Femoral Condyle with Donor-Site Backfill Using Osteochondral Allograft Plug

Guzman, Alvarho; Rueda, Therese Dela; Sol, Shane M. Rayos Del; Bryant, Stewart A.; Jenkins, Sarah M.; Gardner, Brandon; McGahan, Patrick J.; Chen, James L.

doi:10.1016/j.eats.2021.08.012

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…The single-use Autograft OATS ® (osteochondral autograft transfer system) (Arthrex GmbH, Munich, Germany) is a procedure that facilitates the harvesting of 6 to 12 mm osteochondral cartilage cylinders from the superior and lateral femoral condyle using an autograft donor (>3 cm 2 ) [8,9].…”

Section: Mosaicplastymentioning

confidence: 99%

A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation

Gherghel,

Onu,

Iordan

et al. 2024

Biomedicines

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Background: Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes. Materials and Methods: This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee’s range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases. Results: Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments. Conclusions: The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee.

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Section: Mosaicplastymentioning

confidence: 99%

A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation

Gherghel,

Onu,

Iordan

et al. 2024

Biomedicines

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“…If the graft surface protrudes above its surrounding, it may undergo necrosis and excessive wear, 7 which mainly depends on the angle and depth of the graft insertion. 8 Hence, the tubular harvesting chisel must be perpendicular to the articular cartilage surface for graft harvest and insertion to avoid differences in angulation and alignment, 9 – 11 as shown in Fig. 1 .…”

Section: Introductionmentioning

confidence: 99%

ArthroNavi framework: stereo endoscope-guided instrument localization for arthroscopic minimally invasive surgeries

Long,

Chi,

et al. 2023

J. Biomed. Opt.

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.SignificanceAs an example of a minimally invasive arthroscopic surgical procedure, arthroscopic osteochondral autograft transplantation (OAT) is a common option for repairing focal cartilage defects in the knee joints. Arthroscopic OAT offers considerable benefits to patients, such as less post-operative pain and shorter hospital stays. However, performing OAT arthroscopically is an extremely demanding task because the osteochondral graft harvester must remain perpendicular to the cartilage surface to avoid differences in angulation.AimWe present a practical ArthroNavi framework for instrument pose localization by combining a self-developed stereo endoscopy with electromagnetic computation, which equips surgeons with surgical navigation assistance that eases the operational constraints of arthroscopic OAT surgery.ApproachA prototype of a stereo endoscope specifically fit for a texture-less scene is introduced extensively. Then, the proposed framework employs the semi-global matching algorithm integrating the matching cubes method for real-time processing of the 3D point cloud. To address issues regarding initialization and occlusion, a displaying method based on patient tracking coordinates is proposed for intra-operative robust navigation. A geometrical constraint method that utilizes the 3D point cloud is used to compute a pose for the instrument. Finally, a hemisphere tabulation method is presented for pose accuracy evaluation.ResultsExperimental results show that our endoscope achieves 3D shape measurement with an accuracy of <730 μm. The mean error of pose localization is 15.4 deg (range of 10.3 deg to 21.3 deg; standard deviation of 3.08 deg) in our ArthroNavi method, which is within the same order of magnitude as that achieved by experienced surgeons using a freehand technique.ConclusionsThe effectiveness of the proposed ArthroNavi has been validated on a phantom femur. The potential contribution of this framework may provide a new computer-aided option for arthroscopic OAT surgery.

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“… 21 Various techniques recommend harvesting a plug 1 to 2 mm longer than the recipient hole to allow for graft impaction. 4 , 10 , 29 A clinical dilemma exists with regard to leaving an osteochondral plug slightly proud versus subjecting the graft to additional force to seat the graft flush with the surrounding articular cartilage. Thus, a further understanding of the compressibility of the different regions of the distal femur would be advantageous for a surgeon to understand when considering harvest sites for OAT procedures.…”

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confidence: 99%

Compressibility of Osteochondral Autograft Transfer Donor Grafts: A Comparison of Different Donor Regions and How Much Shortening Occurs of Plugs After Impaction

Massey

Kushner

Miller

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral autograft transfer (OAT) is a useful technique for full-thickness cartilage lesions of the distal femur. Various techniques recommend harvesting a plug 2 mm longer than the recipient hole to allow for graft impaction. Grafts with limited compressibility may not sit flush when impacted. Purpose: To compare the compressibility/shortening of OAT donor plug regions from the distal femur of human cadaveric knees after impaction. Study Design: Controlled laboratory study. Methods: A total of 20 cadaveric knees (mean age, 70.3 ± 8.4 years) were divided into 4 donor regions: medial intercondylar (IC) notch, lateral IC notch, medial trochlea, and lateral trochlea. Each region was subdivided into 4 zones: far superior (FSZ), middle superior (MSZ), middle inferior (MIZ), and far inferior (FIZ). A total of 320 grafts (6-mm diameter, 15-mm depth) were extracted, and a custom-built machine was used to strike the graft 5 times using a predetermined energy of 0.11 J. The graft length was measured initially and after each impact. Statistical analysis of the compressibility for each of the 4 regions and all 16 zones was performed utilizing analysis of variance, with post hoc testing using the Fisher’s least significant difference. Results: Compression in the lateral IC notch, medial IC notch, medial trochlea, and lateral trochlea was 2.4 ± 1.5, 2.1 ± 0.7, 3.1 ± 2.2, and 2.1 ± 0.6 mm, respectively, with significant differences between the 4 regions ( P < .01) and the most compression in the medial trochlea ( P < .01). Subgroup analysis showed that the lateral trochlea had higher compressibility for FIZ versus MIZ ( P = .02) and the lateral IC notch had higher compressibility for FSZ versus FIZ and MIZ ( P < .05 for both). Conclusion: Compressibility varied between OAT donor sites in the distal femur. OAT donor grafts showed the highest compressibility in the medial trochlea (3.1 mm) and lateral IC notch FSZ (3.0 mm). Clinical Relevance: The lateral trochlea, medial IC notch, and the lower zones of the lateral IC notch grafts should not be oversized more than 2 mm in length, as these grafts may not compress adequately.

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Arthroscopic Osteochondral Autograft Transfer System Procedure of the Lateral Femoral Condyle with Donor-Site Backfill Using Osteochondral Allograft Plug

Cited by 6 publications

References 27 publications

A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation

A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation

ArthroNavi framework: stereo endoscope-guided instrument localization for arthroscopic minimally invasive surgeries

Compressibility of Osteochondral Autograft Transfer Donor Grafts: A Comparison of Different Donor Regions and How Much Shortening Occurs of Plugs After Impaction

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