Publications by authors named "René Verdonk"

87 Publications

Xenograft for anterior cruciate ligament reconstruction was associated with high graft processing infection.

J Exp Orthop 2020 Oct 7;7(1):79. Epub 2020 Oct 7.

IRCCS Istituto Ortopedici Rizzoli, University of Bologna, Lab. Biomeccanica - Via di Barbiano, 1/10, 40137, Bologna, Italy.

Purpose: To evaluate clinical ad radiological outcomes of anterior cruciate ligament (ACL) reconstruction with an immunochemically modified porcine patellar tendon xenograft controlled against human Achilles tendon allograft at 24-month minimum follow-up.

Methods: 66 patients undergoing arthroscopic ACL reconstruction were randomized into 2 groups: 34 allografts and 32 xenografts treated to attenuate the host immune response. Follow-up was 24-month minimum. Anterior knee stability was measured as KT - 1000 side-to-side laxity difference (respect to the contralateral healthy knee). Functional performance was assessed by one-legged hop test. Objective manual pivot-shift test and subjective (IKDC, Tegner and SF-36) outcomes were collected. MRI and standard X-Ray were performed.

Results: 61 subjects (32 allograft, 29 xenograft) were evaluated at 12 and 24 months. Six of the subjects in xenograft group (20.6%) got an infection attributed to a water-based pathogen graft contamination in processing. Intention-to-treat analysis (using the last observation carried forward imputation method) revealed higher KT - 1000 laxity in xenograft group at 24-month follow-up (P = .042). Also pivot-shift was higher in xenograft group at 12-month (P = .015) and 24-month follow-up (P = .038). Per-protocol analysis (missing/contaminated subjects excluded) did not revealed clinical differences between groups. Tibial tunnel widening in the allograft group was low, whereas xenograft tunnel widening was within the expected range of 20-35% as reported in the literature. No immunological reactivity was associated to xenograft group.

Conclusions: High infection rate (20.6%) was reported in xenograft group. Both groups of patients achieved comparable clinical outcomes if missing/contaminated subjects are excluded. Improved harvesting/processing treatments in future studies using xenografts for ACL reconstruction are needed to reduce infection rate, otherwise xenograft should not be used in ACL reconstruction.

Level Of Evidence: Multicenter and double-blinded Randomized Controlled Clinical Trial, Level I.
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http://dx.doi.org/10.1186/s40634-020-00292-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541808PMC
October 2020

Autogenous Osteochondral Grafting for Treatment of Knee Osteochondritis Dissecans: A Case Series Study.

Arch Bone Jt Surg 2020 May;8(3):426-431

Akhtar Orthopedic Training and Research Hospital, Shahid Beheshti University of medical Sciences, Tehran, Iran.

Background: Although some surgical techniques have been described for the operative treatment of unstable Osteochondritis dissecans (OCD) of the knee, outcomes are variable and are not satisfying totally. The aim of the present study is to evaluate the outcomes of autogenous osteochondral grafting for OCD of the knee.

Methods: In a case series study, from June 2014 to July 2015, 16 patients with stage II-IV OCD (International Cartilage Repair Society (ICRS)) of the femoral condyle were investigated. Surgical intervention considered in cases of stage III (4 cases) and IV (2 cases) and in stage II (10 cases) ones that were nonresponsive to conservative treatment. At the initial and final visits, the IKDC, Lysholm score and Tegner activity scale were evaluated.

Results: The mean preoperative IKDC score (53.4) increased significantly following surgery (84.3) (). Based on the IKDC grading system, before the operation, the knee status was graded as nearly normal, abnormal, and severely abnormal in 4, 10, and 2 patients, respectively. At final post-surgical follow up, 15 normal and 1 abnormal knee were documented (). The mean Lysholm score increased from 44.3 per operatively to 86.3 ().Tegner activity score improved from 2.8±1 pre operatively to 5.6±2 ().

Conclusion: Surgical treatment of unstable OCD using autogenous osteochondral graft shows successful outcomes. In addition to reliable fixation, it can enhance healing and convert an uncontained lesion to contained one appropriate for autogenous osteochondral grafting with healthy cartilage.
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http://dx.doi.org/10.22038/abjs.2019.39026.2038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358228PMC
May 2020

Matrix-Augmented Bone Marrow Stimulation With a Polyglycolic Acid Membrane With Hyaluronan vs Microfracture in Local Cartilage Defects of the Femoral Condyles: A Multicenter Randomized Controlled Trial.

Orthop J Sports Med 2020 May 29;8(5):2325967120922938. Epub 2020 May 29.

OCM Munich, München, Germany.

Background: Microfracture (MF) is an established operative treatment for small, localized chondral defects of the knee joint. There is evidence from animal studies that matrix augmentation of bone marrow stimulation (m-BMS) can improve the quality of the repair tissue formation.

Purpose: To evaluate the therapeutic outcome of a matrix made of polyglycolic acid and hyaluronan as compared with a conventional MF technique.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Patients between the ages of 18 and 68 years who had an articular femoral cartilage defect of 0.5 to 3 cm in the weightbearing area of the femoral condyles with indication for MF were included in this study. Patients were randomized and treated with either MF or m-BMS with Chondrotissue. Defect filling, as assessed on magnetic resonance imaging (MRI), at postoperative 12 weeks was defined as the primary outcome measure, with follow-up MRI at weeks 54 and 108. Follow-up data were also collected at 12, 54, and 108 weeks after surgery and included patient-reported clinical scores: visual analog scale for pain, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score, and 36-Item Short Form Health Survey.

Results: MRI scans confirmed cartilage repair tissue formation in both groups 12 weeks after treatment. There was no significant difference between the m-BMS and MF groups in the percentage of defect filling at 12, 54, and 108 weeks postoperatively. No significant difference was found in terms of patient-reported clinical scores. Both groups showed significant improvement in 4 KOOS subscales-Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life-at 54 and 108 weeks after treatment.

Conclusion: This is the first randomized controlled trial comparing m-BMS with a polyglycolic acid matrix with hyaluronan with MF. The use of the Chondrotissue implant in m-BMS has been proven to be a safe procedure. No difference was found between m-BMS and MF in terms of patient-reported outcome scores and MRI assessment until postoperative 2 years. Long-term follow-up studies including histological assessment are desirable for further investigation.

Registration: EUCTR2011-003594-28-DE (EU Clinical Trials Register).
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http://dx.doi.org/10.1177/2325967120922938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263152PMC
May 2020

Polyurethane Meniscal Scaffold for the Treatment of Partial Meniscal Deficiency: 5-Year Follow-up Outcomes: A European Multicentric Study.

Am J Sports Med 2020 May 8;48(6):1347-1355. Epub 2020 Apr 8.

Investigation performed at the Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.

Background: A biodegradable polyurethane scaffold was developed to treat patients with the challenging clinical condition of painful partial meniscal defects.

Hypothesis: The use of an acellular polyurethane scaffold in patients with symptomatic partial meniscal defects would result in both midterm pain relief and improved function.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 155 patients with symptomatic partial meniscal defects (101 medial and 54 lateral) were implanted with a polyurethane scaffold in a prospective, single-arm, multicentric study with a minimum 5-year follow-up. Clinical outcomes were measured with the visual analog scale for pain, International Knee Documentation Committee subjective knee evaluation form, Lysholm knee scale, and Knee injury and Osteoarthritis Outcome Score at baseline and at 2- and 5-year follow-ups. Magnetic resonance imaging (MRI) was used to evaluate the knee joint, meniscal implant, and meniscal extrusion. Kaplan-Meier survival analysis was also performed. Removal of the scaffold, conversion to a meniscal transplant, and unicompartmental/total knee arthroplasty were used as endpoints.

Results: Eighteen patients were lost to follow-up (11.6%). The patients who were included in this study showed significant clinical improvement after surgery as indicated by the different outcome measures ( = .01). However, the clinical improvement tended to stabilize between 2 and 5 years of follow-up. MRI scans of the scaffolds in 56 patients showed a smaller-sized implant in the majority of the cases when compared with the native meniscus with an irregular surface at the 5-year follow-up. During the follow-up period, 87.6% of the implants survived in this study. At 5 years of follow-up, 87.9% of the medial scaffolds were still functioning versus 86.9% of the lateral scaffolds. In total, 23 treatments had failed: 10 removed scaffolds because of breakage, 7 conversions to meniscal allograft transplantation, 4 conversions to unicompartmental knee arthroplasty, and 2 conversions to total knee arthroplasty.

Conclusion: The polyurethane meniscal implant was able to improve knee joint function and reduce pain in patients with segmental meniscal deficiency over 5 years after implantation. The MRI appearance of this scaffold was different from the original meniscal tissue at the midterm follow-up. The treatment survival rates of 87.9% of the medial scaffolds and 86.9% of the lateral scaffolds in the present study compared favorably with those published concerning meniscal allograft transplantation after total meniscectomy.
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http://dx.doi.org/10.1177/0363546520913528DOI Listing
May 2020

Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus.

Knee Surg Sports Traumatol Arthrosc 2020 Apr 13;28(4):1177-1194. Epub 2020 Feb 13.

Department of Orthopedics and Traumatology, Centre of Joint Replacement, Hospital Brandenburg, Medical School "Theodor Fontane", Hochstrasse 29, 14770, Brandenburg/Havel, Germany.

Purpose: The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts.

Methods: Three groups of surgeons and scientists elaborated and ratified the so-called formal consensus process to define the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defined as a tear with an acute onset of symptoms caused by a sufficient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientific literature. The quality of the answers received grades of A (a high level of scientific support), B (scientific presumption), C (a low level of scientific support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (= totally inappropriate) to 9 (= totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the finalized question and answer sets were submitted for final review by the peer review group composed of representatives of the ESSKA-affiliated national societies. Eighteen representatives replied.

Results: The review of the literature revealed a rather low scientific quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientific support), and another received a grade of B (scientific presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confidence interval 8.1-8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identified. Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair.

Discussion: The consensus was generated to present the best possible recommendations for the treatment of traumatic meniscus tears and provides some groundwork for a clinical decision-making process regarding the treatment of meniscus tears. Preservation of the meniscus should be the first line of treatment when possible, because the clinical and radiological long-term outcomes are worse after partial meniscectomy than after meniscus preservation. The consensus clearly states that numerous meniscus tears that were considered irreparable should be repaired, e.g., older tears, tears in obese patients, long tears, etc. LEVEL OF EVIDENCE: II.
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http://dx.doi.org/10.1007/s00167-020-05847-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148286PMC
April 2020

Meniscus Scaffolds for Partial Meniscus Defects.

Clin Sports Med 2020 Jan;39(1):83-92

Orthoca, Kielsevest 14, Antwerp 2018, Belgium. Electronic address:

The meniscus is a crucial player in knee joint homeostasis. Loss of meniscus tissue can result in early onset of clinical symptoms like pain and loss of function, and structural degeneration of the articular cartilage. In case of a symptomatic segmental defect of the medial or lateral meniscus, different innovative options using biological or synthetic scaffolds are now available to regenerate meniscuslike tissue, with the aim of allowing a satisfactory clinical improvement to patients. However, the role of any of these procedures in terms of chondroprotection is questionable, and the overall outcomes in the long term still can be improved.
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http://dx.doi.org/10.1016/j.csm.2019.08.011DOI Listing
January 2020

Good mid-term outcomes after adipose-derived culture-expanded mesenchymal stem cells implantation in knee focal cartilage defects.

Knee Surg Sports Traumatol Arthrosc 2020 Feb 6;28(2):502-508. Epub 2019 Sep 6.

Department of Orthopaedic Surgery and Traumatology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.

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/m (range 19-29) and an average size of the lesion of 3.5 cm (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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http://dx.doi.org/10.1007/s00167-019-05688-9DOI Listing
February 2020

Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel.

J Knee Surg 2020 Apr 6;33(4):410-416. Epub 2019 Feb 6.

Department of Orthopedic Surgery, Orthopaedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24-51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.
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http://dx.doi.org/10.1055/s-0039-1677812DOI Listing
April 2020

Modern treatment of meniscal tears.

EFORT Open Rev 2018 May 21;3(5):260-268. Epub 2018 May 21.

Ghent University, Faculty of Medicine, Department of Orthopaedics and Traumatology, De Pintelaan, Ghent, Belgium.

The complex ultrastructure of the meniscus determines its vital functions for the knee, the lower extremity, and the body.The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue.It is the orthopaedic surgeon's responsibility to combine clinical information, radiological images, and clinical experience in an effort to individualize management of meniscal tears, taking into account factors related to the patient and lesion.Surgeons should strive not to operate in most cases, but to protect, repair or reconstruct, in order to prevent early development of osteoarthritis by restoring the native structure, function, and biomechanics of the meniscus.Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. Meniscus surgery has come a long way from the old slogan, "If it is torn, take it out!" to the currently accepted slogan, "Save the meniscus!" which has guided evolving modern treatment methods for meniscal tears. This last slogan will probably constitute the basis for newer alternative biological treatment methods in the future. Cite this article: 2018;3 DOI: 10.1302/2058-5241.3.170067.
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http://dx.doi.org/10.1302/2058-5241.3.170067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994634PMC
May 2018

Arthroscopic Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee: Complete Synovectomy and Septum Removal-Midterm Results.

J Knee Surg 2019 May 4;32(5):427-433. Epub 2018 May 4.

Department of Orthopaedics, Orthopaedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

The purpose of this study was to evaluate and describe the clinical results of complete arthroscopic synovectomy through the four arthroscopic portals in the knees affected by diffuse pigmented villonodular synovitis (DPVNS). Between 2009 and 2012, 21 patients (15 men and 6 women) with the diffuse form of PVNS of the knee were enrolled in the study after qualification. The clinical diagnosis was confirmed by magnetic resonance imaging and postsurgical pathologic examination. All patients underwent complete synovectomy through posteromedial, posterolateral, anteromedial, and anterolateral portals. Each patient was evaluated before treatment and followed up for a minimum of 5 years (range: 60-79 months) using the Lysholm score and International Knee Documentation Committee (IKDC) score. Both Lysholm score and IKDC scores were significantly improved in all study participants. No cases of clinical recurrence, infection, joint stiffness, or neurovascular lesions were observed. This study showed that an attentive arthroscopic synovectomy is a safer alternative with better clinical outcomes, with no clinical recurrences.
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http://dx.doi.org/10.1055/s-0038-1646929DOI Listing
May 2019

A multilayer biomaterial for osteochondral regeneration shows superiority vs microfractures for the treatment of osteochondral lesions in a multicentre randomized trial at 2 years.

Knee Surg Sports Traumatol Arthrosc 2018 Sep 14;26(9):2704-2715. Epub 2017 Sep 14.

Humanitas University Department of Biomedical Sciences - Humanitas Clinical and Research Center, Milan, Italy.

Purpose: The increasing awareness on the role of subchondral bone in the etiopathology of articular surface lesions led to the development of osteochondral scaffolds. While safety and promising results have been suggested, there are no trials proving the real potential of the osteochondral regenerative approach. Aim was to assess the benefit provided by a nanostructured collagen-hydroxyapatite (coll-HA) multilayer scaffold for the treatment of chondral and osteochondral knee lesions.

Methods: In this multicentre randomized controlled clinical trial, 100 patients affected by symptomatic chondral and osteochondral lesions were treated and evaluated for up to 2 years (51 study group and 49 control group). A biomimetic coll-HA scaffold was studied, and bone marrow stimulation (BMS) was used as reference intervention. Primary efficacy measurement was IKDC subjective score at 2 years. Secondary efficacy measurements were: KOOS, IKDC Knee Examination Form, Tegner and VAS Pain scores evaluated at 6, 12 and 24 months. Tissue regeneration was evaluated with MRI MOCART scoring system at 6, 12 and 24 months. An external independent agency was involved to ensure data correctness and objectiveness.

Results: A statistically significant improvement of all clinical scores was obtained from basal evaluation to 2-year follow-up in both groups, although no overall statistically significant differences were detected between the two treatments. Conversely, the subgroup of patients affected by deep osteochondral lesions (i.e. Outerbridge grade IV and OCD) showed a statistically significant better IKDC subjective outcome (+12.4 points, p = 0.036) in the coll-HA group. Statistically significant better results were also found for another challenging group: sport active patients (+16.0, p = 0.027). Severe adverse events related to treatment were documented only in three patients in the coll-HA group and in one in the BMS group. The MOCART score showed no statistical difference between the two groups.

Conclusions: This study highlighted the safety and potential of a biomimetic implant. While no statistically significant differences were found compared to BMS for chondral lesions, this procedure can be considered a suitable option for the treatment of osteochondral lesions.

Level Of Evidence: I.
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http://dx.doi.org/10.1007/s00167-017-4707-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105149PMC
September 2018

Meniscal allograft transplantation: a meta-analysis.

SICOT J 2017 21;3:33. Epub 2017 Apr 21.

Department of Orthopaedic Surgery, Campus Erasme, University Libre de Bruxelles, Route de Lennik 808, 1070 Anderlecht, Belgium.

Purpose: This meta-analysis evaluates the mid- to long-term survival outcome of MAT (meniscal allograft transplantation). Potential prognosticators, with particular focus on chondral status and age of the patient at the time of transplantation, were also analysed.

Study Design: Meta-analysis.

Methods: An online database search was performed using following search string: "meniscal allograft transplantation" and "outcome". A total of 65 articles were analysed for a total of 3157 performed MAT with a mean follow-up of 5.4 years. Subjective and clinical data was analysed.

Results: The subjective and objective results of 2977 patients (3157 allografts) were analysed; 70% were male, 30% were female. Thirty-eight percent received an isolated MAT. All other patients underwent at least one concomitant procedure. Lysholm, Knee injury and Osteoarthritis Outcome (KOOS), International Knee Documentation Committee (IKDC) and Visual Analogue Scale (VAS) scores were analysed. All scores showed a good patient satisfaction at long-term follow-up. The mean overall survival rate was 80.9%. Complication rates were comparable to standard meniscal repair surgery. There was a degenerative evolution in osteoarthritis with at least one grade in 1760 radiographically analysed patients. Concomitant procedures seem to have no effect on the outcome. Age at transplantation is a negative prognosticator. The body mass index (BMI) of the patient shows a slightly negative correlation with the outcome of MAT.

Conclusions: MAT is a viable solution for the younger patient with chronic pain in the meniscectomised knee joint. The complications are not severe and comparable to meniscal repair. The overall failure rate at final follow-up is acceptable and the allograft heals well in most cases, but MAT cannot be seen as a definitive solution for post-meniscectomy pain. The correct approach to the chronic painful total meniscectomised knee joint thus requires consideration of all pathologies including alignment, stability, meniscal abnormality and cartilage degeneration. It requires possibly combined but appropriate action in that order.
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http://dx.doi.org/10.1051/sicotj/2017016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406844PMC
April 2017

Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view.

Knee Surg Sports Traumatol Arthrosc 2017 Feb 27;25(2):454-458. Epub 2016 Dec 27.

Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: The purpose of this study was to evaluate and describe the clinical results and outcomes of a novel method for all-inside suture repair of medial meniscus ramp lesions through posteromedial and posterolateral transseptal portals during anterior cruciate ligament (ACL) reconstruction. Further, this investigation compared the posterolateral view to the notch view for diagnosis and repair.

Methods: Between 2011 and 2014, 166 patients had ramp lesions concomitantly with ACL injury; 128 patients (107 men and 21 women) were enrolled in the study after qualification. All patients underwent repair of the posterior horn ramp lesion of the medial meniscus, using a suture hook device with PDS No. 1 through a posteromedial portal while viewing from the posterolateral transseptal portal during ACL reconstruction, with a minimum of a 2-year follow-up.

Results: Patients were followed up for a minimum of 2 years (range 24-47 months). Their average Lysholm score increased from 61.7 ± 3.2 preoperatively to 87.8 ± 3.9 at last follow-up (p < 0.001). Moreover, their average IKDC scores also improved from 53.6 ± 2.1 (pre-op) to 82.1 ± 3.5 (at last follow-up) (p < 0.001). The peroneal nerve and the popliteal neurovascular bundle were not damaged in any of the patients.

Conclusion: This study provides evidence that the posterolateral transseptal technique protects neurovascular structures. This technique may be used safely and easily for repair of the posterior horn ramp lesion of the medial meniscus during ACL reconstruction.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-016-4410-9DOI Listing
February 2017

Treatment of Painful, Irreparable Partial Meniscal Defects With a Polyurethane Scaffold: Midterm Clinical Outcomes and Survival Analysis.

Am J Sports Med 2016 Oct 18;44(10):2615-2621. Epub 2016 Jul 18.

Department of Physiotherapy and Orthopaedics, Faculty of Medicine, Ghent University, Ghent, Belgium.

Background: A biodegradable polyurethane scaffold was designed to fulfill a challenging clinical need in the treatment of patients with painful, irreparable partial meniscal defects.

Hypothesis: The use of an acellular polyurethane scaffold for new tissue generation in irreparable, partial meniscal defects provides both midterm pain relief and improved functionality.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 44 patients with irreparable, partial meniscal defects (29 medial and 15 lateral) were implanted with a polyurethane scaffold in a prospective, single-arm proof-of-principle study with a minimum 5-year follow-up. Clinical outcomes were measured with the visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline and at 2- and 5-year follow-up. Magnetic resonance imaging (MRI) was used to evaluate the meniscal implant and cartilage status of the index compartment. Kaplan-Meier time-to-treatment failure distributions were also performed. Removal of the scaffold, conversion to a meniscal transplant, or unicompartmental/total knee arthroplasty was used as endpoints.

Results: Seven patients were lost to follow-up (15.9%). The patients who participated in this study showed significant clinical improvement after surgery (mean [±SD] at baseline, 2 years, and 5 years: 56.2 ± 21.6, 24.6 ± 22.7, and 19.3 ± 26.9, respectively [VAS]; 206.5 ± 79.7, 329.8 ± 108.9, and 333.6 ± 112.2, respectively [total KOOS]). MRI of the scaffolds showed a smaller sized implant when compared with the native meniscus with an irregular surface at 2- and 5-year follow-up. A stable cartilage status of the index compartment at 5-year follow-up was demonstrated in 46.7% of patients compared with the baseline status. During the follow-up period, 62.2% of the implants survived. At final follow-up, 66.7% of the medial scaffolds were still functioning versus 53.8% of the lateral scaffolds.

Conclusion: A polyurethane meniscal implant can improve knee joint function and significantly reduce pain in patients with segmental meniscus deficiency up to 5 years after implantation. A stable cartilage status of the index compartment at 5-year follow-up was demonstrated in 46.7% of patients, calling into question the chondroprotective ability of the implant. In addition, a relatively high failure rate was noticed. Long-term and randomized controlled studies are mandatory to confirm the initial results and the reliability of this procedure.
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http://dx.doi.org/10.1177/0363546516652601DOI Listing
October 2016

The role of meniscal tissue in joint protection in early osteoarthritis.

Knee Surg Sports Traumatol Arthrosc 2016 Jun 16;24(6):1763-74. Epub 2016 Apr 16.

Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.

It is widely accepted that partial meniscectomy leads to early onset of osteoarthritis (OA). A strong correlation exists between the amount and location of the resected meniscus and the development of degenerative changes in the knee. On the other hand, osteoarthritic changes of the joint alter the structural and functional integrity of meniscal tissue. These alterations might additionally compromise the limited healing capacity of the meniscus. In young, active patients without cartilage damage, meniscus therapy including partial meniscectomy, meniscus suture, and meniscus replacement has proven beneficial effects in long-term studies. Even in an early osteoarthritic milieu, there is a relevant regenerative potential of the meniscus and the surrounding cartilage. This potential should be taken into account, and meniscal surgery can be performed with the correct timing and the proper indication even in the presence of early OA.
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http://dx.doi.org/10.1007/s00167-016-4069-2DOI Listing
June 2016

Load distribution in early osteoarthritis.

Knee Surg Sports Traumatol Arthrosc 2016 Jun 16;24(6):1815-25. Epub 2016 Apr 16.

Department of Orthopaedics and Trauma, Jan Palfijn Ziekenhuis, 9000, Ghent, Belgium.

Total knee replacement is an accepted standard of care for the treatment of advanced knee osteoarthritis with good results in the vast majority of older patients. The use in younger and more active populations, however, remains controversial due to concerns over activity restrictions, implant survival, and patient satisfaction with the procedure. It is in these younger patient populations that alternatives to arthroplasty are increasingly being explored. Historically, osteotomy was utilized to address unicompartmental pain from degeneration and overload, for example, after meniscectomy. Utilization rates of osteotomy have fallen in recent years due to the increasing popularity of partial and total knee arthroplasty. This article explores the indications and outcomes of traditional unloading osteotomy, as well as newer options that are less invasive and offer faster return to function.
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http://dx.doi.org/10.1007/s00167-016-4123-0DOI Listing
June 2016

Clinical and MRI outcome of an osteochondral scaffold plug for the treatment of cartilage lesions in the knee.

Acta Orthop Belg 2015 Dec;81(4):629-38

Conflicting clinical outcomes have been reported recently with the use of an osteochondral scaffold plugs for cartilage repair in the knee. In this study, twenty patients were consecutively treated for their cartilage lesions with the synthetic plug technique. These patients were prospectively clinically evaluated with a mean follow-up of 34.15 months. Magnetic resonance imaging (MRI) was used for morphologic analysis of the cartilage repair. The patients included in this study showed a significant gradual clinical improvement after the osteochondral scaffold plug. However, this clinical improvement was not confirmed by the MRI findings of this cohort study. Subchondral bone changes were seen in all patients on MRI and deficient filling of the defect was noticed in in 30.7% of the cases at 24 months of follow-up. There was no evidence found to support osteoconductive bone ingrowth. Therefore, the use of this type of osteochondral scaffold plug in osteochondral repair is questionable. Level of evidence: IV.
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December 2015

Biological methods to enhance bone healing and fracture repair.

Arthroscopy 2015 Apr 11;31(4):715-8. Epub 2015 Feb 11.

Orthopaedic and Trauma Department, Monica Ziekenhuizen, Antwerp, Belgium.

This article looks into normal physiological fracture healing with special emphasis on the diamond concept. A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti-inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented.
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http://dx.doi.org/10.1016/j.arthro.2014.11.045DOI Listing
April 2015

Focusing on results after meniscus surgery.

Knee Surg Sports Traumatol Arthrosc 2015 Jan;23(1):3-7

Department of Orthopaedics and Traumatology, Centre Hospitalier de Versailles, 78150, Le Chesnay, France,

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http://dx.doi.org/10.1007/s00167-014-3471-xDOI Listing
January 2015

In-vivo evaluation of the kinematic behavior of an artificial medial meniscus implant: A pilot study using open-MRI.

Clin Biomech (Bristol, Avon) 2014 Sep 17;29(8):898-905. Epub 2014 Jul 17.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium; Antwerp Orthopedic Center, Monica Hospitals, Harmoniestraat 68, 2018 Antwerp, Belgium. Electronic address:

Background: In this pilot study we wanted to evaluate the kinematics of a knee implanted with an artificial polycarbonate-urethane meniscus device, designed for medial meniscus replacement. The static kinematic behavior of the implant was compared to the natural medial meniscus of the non-operated knee. A second goal was to evaluate the motion pattern, the radial displacement and the deformation of the meniscal implant.

Methods: Three patients with a polycarbonate-urethane implant were included in this prospective study. An open-MRI was used to track the location of the implant during static weight-bearing conditions, within a range of motion of 0° to 120° knee flexion. Knee kinematics were evaluated by measuring the tibiofemoral contact points and femoral roll-back. Meniscus measurements (both natural and artificial) included anterior-posterior meniscal movement, radial displacement, and meniscal height.

Findings: No difference (P>0.05) was demonstrated in femoral roll-back and tibiofemoral contact points during knee flexion between the implanted and the non-operated knees. Meniscal measurements showed no significant difference in radial displacement and meniscal height (P>0.05) at all flexion angles, in both the implanted and non-operated knees. A significant difference (P ≤ 0.05) in anterior-posterior movement during flexion was observed between the two groups.

Interpretation: In this pilot study, the artificial polycarbonate-urethane implant, indicated for medial meniscus replacement, had no influence on femoral roll-back and tibiofemoral contact points, thus suggesting that the joint maintains its static kinematic properties after implantation. Radial displacement and meniscal height were not different, but anterior-posterior movement was slightly different between the implant and the normal meniscus.
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http://dx.doi.org/10.1016/j.clinbiomech.2014.07.001DOI Listing
September 2014

The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair.

Knee Surg Sports Traumatol Arthrosc 2015 Aug 22;23(8):2208-2212. Epub 2014 Apr 22.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.

Purpose: This study was designed to describe the clinical and radiographical outcome of the HemiCAP(®) resurfacing system as a salvage treatment for a failed index cartilage procedure.

Methods: Fourteen patients were treated consecutively and clinically prospectively followed for a mean period of 26.1 ± 12.8 months. All patients were previously treated for their cartilage lesion. Radiographical data were analysed based on the Kellgren and Lawrence system.

Results: The patients involved in this study demonstrated a gradual clinical improvement in time. However, radiographically significant osteoarthritic changes were observed during the follow-up period. The position of the HemiCAP(®) resurfacing system was adequate in all cases, and no signs of loosening were observed during the follow-up period.

Conclusions: The HemiCAP(®) resurfacing system is feasible as a salvage treatment for a failed index cartilage procedure and resulted in a gradual clinical improvement. However, the favourable clinical outcome was not confirmed by the radiographical findings.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-014-2999-0DOI Listing
August 2015

What is the best way to fix a polyurethane meniscal scaffold? A biomechanical evaluation of different fixation modes.

Knee Surg Sports Traumatol Arthrosc 2015 Jan 12;23(1):59-64. Epub 2013 Apr 12.

Knee and Sports Traumatology Unit, Orthopaedic Department, Leuven University Hospital, Weligerveld 1, 3212, Pellenberg, Belgium,

Purpose: Ingrowth of meniscal tissue into a meniscal scaffold can be optimized by securely fixing the scaffold into the meniscal remnants. The purpose of this research was to test and compare commonly used suture types and suture materials to fix a meniscal scaffold.

Methods: Forty fresh porcine menisci were used. All tests used the same polyurethane-based scaffold. The load to failure of horizontal, vertical and diagonal sutures with PDS 0 and with Ethibond 0, and diagonal sutures with Ultra Fast-Fix(®) and Sequent(®) to fix a meniscal scaffold were tested. Five tests were conducted for each configuration.

Results: All constructs failed in the scaffold at a mean pullout force of 50.6 N (SD 12.7). Inferior results were noted for vertical sutures (40.1 N, SD 6.3) compared to horizontal (49.8 N, SD 5.5, p = 0.0007) and diagonal (51.7 N, SD 15.6, p = 0.024) sutures and for Ethibond 0 (41.4 N, SD 6.2) compared to PDS 0 (51.3 N, SD 12.9, p = 0.001). When comparing the diagonal suture placements, only Ethibond 0 (42.9 N, SD 5.4) showed significantly inferior results compared to PDS 0 (60.1 N, SD 16.9, p = 0.03), Ultra Fast-Fix(®) (60.1 N, SD 9.3, p = 0.004) and Sequent(®) (65.8 N, SD 4.4, p < 0.0001).

Conclusions: The most common failure mode when fixing a polyurethane-based meniscal scaffold is suture pull-through of the scaffold in the distraction mode. This happens at a rather low pullout force and might preclude the use of this scaffold clinically. Vertical sutures and Ethibond 0 multifilament braided sutures fail at lower forces, and the tested commercial devices show promising results.
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http://dx.doi.org/10.1007/s00167-013-2495-yDOI Listing
January 2015

Open versus arthroscopic meniscus allograft transplantation: magnetic resonance imaging study of meniscal radial displacement.

Arthroscopy 2013 Mar;29(3):514-21

Department of Radiology, Ghent University Hospital, Ghent, Belgium.

Purpose: In this imaging study, the radial displacement of meniscal allograft transplants (MATs), inserted with 2 different techniques, namely open soft-tissue fixation and arthroscopic bone tunnel fixation, was compared 1 year postoperatively.

Methods: In this study, 37 patients received MATs: 16 MATs (10 lateral and 6 medial) were inserted by an open soft-tissue technique (open MATs), whereas 21 MATs (14 lateral and 7 medial) were implanted by an arthroscopic bone tunnel procedure (arthroscopic MATs). Radial displacement, in millimeters, was evaluated 1 year postoperatively on 1.5-T magnetic resonance images. The number of MATs with radial displacement larger or smaller than 3 mm was determined. To compare radial displacement of open versus arthroscopic MATs, the Mann-Whitney U test was used.

Results: The radial displacement of open lateral and medial MATs was significantly larger (all reported P < .02) than that of arthros-copic MATs. In all cases, both open and arthroscopic, the radial displacement of MATs was significantly larger (all reported P < .007) than that of normal menisci. Radial displacement of less than 3 mm was found in 0 of 6 patients with open medial MATs versus 6 of 7 patients with arthroscopic MATs and was found in 1 of 10 patients with open lateral MATs versus 4 of 14 patients with arthroscopic MATs.

Conclusions: The radial displacement of MATs arthroscopically inserted with bone tunnel fixation is significantly less than the radial displacement of MATs inserted with open soft-tissue fixation. In addition, normal menisci displace significantly less than meniscal allografts. The clinical importance of radial displacement remains to be determined.

Level Of Evidence: Level III, retrospective comparative study.
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http://dx.doi.org/10.1016/j.arthro.2012.10.029DOI Listing
March 2013

Expandable intramedullary nails for fixation of tibial shaft fractures.

Acta Orthop Belg 2012 Dec;78(6):779-85

Saint-Pierre University Hospital, Brussels.

Interlocking intramedullary nailing is currently the preferred treatment for most tibial fractures requiring operative treatment, with good results and a relatively low complication rate as reported in large clinical series. However, vascular and neurological complications caused by interlocking screws have been reported. In addition, insertion of distal interlocking screws can be technically demanding and may entail substantial exposure. We present the results with an expandable self-locking nail in the management of 52 AO type A and B tibial shaft fractures. The mean time to union was 15.8 weeks and the rate of union was 98%. The average surgical time was 60 minutes. Complications were those usually seen in diaphysis nailing and no complication was noted during nail expansion. Interlocking screws are not necessary, which reduces the risk of iatrogenic lesions. The expandable nail allows effective management of AO type A and B diaphyseal fractures of the tibia, a lower radiation exposure and shorter operative time.
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December 2012

Revision of meniscal transplants: long-term clinical follow-up.

Knee Surg Sports Traumatol Arthrosc 2014 Feb 12;22(2):351-6. Epub 2013 Feb 12.

Department of Orthopaedic Surgery and Traumatology 1P5, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium,

Purpose: The primary aim is to document objective and subjective clinical outcome after knee arthroplasty for failed meniscal allograft transplantation; secondly, to investigate the influence of previous meniscal allograft surgery on the clinical outcome after a knee arthroplasty procedure; thirdly, to identify possible prognostic factors for the failure of meniscal allograft, such as potential number of concomitant procedures or pre-transplantation HSS-scores. The study population was compared to a control group of primary total knee arthroplasties.

Methods: The pre-operative phase, prior to meniscal allograft transplantation, was evaluated by the HSS questionnaire. At final follow-up, the clinical outcome was evaluated by the HSS, KOOS and SF-36 questionnaires. The mean follow-up was 16 years and 2 months. The control group, matched for age and sex, comprised patients with primary total knee arthroplasty.

Results: Statistical analysis showed that for the HSS-scores, there was no significant difference between the study population and the control group. KOOS data showed that the control group scored better overall. There was no significant difference between the HSS-scores after the transplantation and after the knee prosthesis. However, both showed a significant improvement regarding the clinical condition before meniscal transplantation.

Conclusions: The clinical results after revised meniscal transplantation by means of knee prosthesis are highly variable with a tendency to have a lower score than patients with a primary knee prosthesis. Patients who underwent a revision of their meniscal allograft transplantation by means of a knee arthroplasty still had a significant better clinical outcome than prior to the meniscal allograft transplantation. There were no prognostic factors found by which one can determine whether a meniscal allograft will have a good survival or not.
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http://dx.doi.org/10.1007/s00167-013-2439-6DOI Listing
February 2014

Two-year follow-up study on clinical and radiological outcomes of polyurethane meniscal scaffolds.

Am J Sports Med 2013 Jan 1;41(1):64-72. Epub 2012 Nov 1.

Department of Radiology, Ghent University Hospital, Belgium.

Background: Little is known about radial displacement (RD) of polyurethane (PU) scaffolds, intended for partial meniscus defect substitution; no data are available on whether rim thickness influences RD and whether RD correlates with clinical outcome scores.

Hypotheses: The meniscus is not extruded preoperatively, but RD occurs after scaffold implantation. A thicker rim will limit RD, and there is no correlation between RD and clinical outcome.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty-six patients were implanted with a PU scaffold (8 lateral, 18 medial). Radial displacement (mm) was evaluated on magnetic resonance images preoperatively and at 3 months, 1 year, and 2 years postoperatively. At each time point, it was determined whether a correlation existed between the rim and RD. Clinical outcome was determined using a visual analog scale (VAS) for pain as well as the Lysholm knee scoring scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) score.

Results: Radial displacement of lateral scaffolds was not significantly different (P = .178) either preoperatively (mean ± SD, 3.42 ± 0.99 mm) or at 3 months (4.82 ± 0.59 mm), 1 year (4.55 ± 0.87 mm), or 2 years postoperatively (4.10 ± 0.93 mm). No correlation was observed between the rim and lateral RD at all time points. Medial scaffold RD increased significantly (P < .001) from preoperative values (2.17 ± 0.84 mm) to those at 3 months (4.25 ± 0.89 mm), 1 year (4.43 ± 1.01 mm), and 2 years postoperatively (4.41 ± 0.96 mm). A strong negative correlation between medial RD and the rim was observed at all time points. There was no significant correlation between clinical outcome scores and RD, either preoperatively or postoperatively.

Conclusion: This study demonstrated that limited medial meniscal RD was present preoperatively but increased by 2 mm after scaffold implantation. Lateral RD was also present preoperatively but did not increase after scaffold implantation. Importantly, a strong negative correlation was found between the rim and postoperative medial RD; a thicker rim limited RD. However, in the lateral compartment, rim thickness did not correlate with RD because RD was already strongly present preoperatively. Finally, no correlations were observed between scaffold RD and clinical outcome scores, either preoperatively or postoperatively.
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http://dx.doi.org/10.1177/0363546512463344DOI Listing
January 2013

Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis.

Knee Surg Sports Traumatol Arthrosc 2013 Sep 26;21(9):1967-76. Epub 2012 Oct 26.

Department of Orthopedic Surgery and Traumatology, University Hospitals Leuven, Leuven, Belgium, Weligerveld 1, 3212, Pellenberg, Belgium.

Purpose: Although the occurrence of early osteoarthritis (OA) is commonly associated with a history of anterior cruciate ligament (ACL) reconstruction, its exact prevalence in these patients remains unknown. The goal of this study was to review the current literature on long-term radiographic outcome after autologous ACL reconstruction and subsequently perform a meta-analysis to obtain evidence-based prevalences of OA at a mean of 10 years after surgery. In addition, this report aimed at identifying the relationship between meniscal status and the occurrence of radiographic OA in the ACL reconstructed knee.

Methods: A systematic review of the literature was performed in PubMed MEDLINE, EMBASE and Cochrane Library databases to identify all studies concerning radiographic outcome after autologous ACL reconstruction with a follow-up of minimum 10 years. Meta-analyses were performed to obtain the average prevalence of OA and the difference between patients with and without meniscectomy. Considered study estimates were the log-transformed odds and odds ratios, the latter expressing the effect of meniscectomy on OA.

Results: A total of 16 studies could be included for meta-analysis, accounting for 1554 ACL reconstructions performed between 1978 and 1997. Of these knees, 453 (28%) showed radiological signs of osteoarthritis (IKDC grade C or D). Furthermore, 50% of the patients with meniscectomy had osteoarthritis, compared with 16% of the patients without meniscectomy. The combined odds ratio for meniscectomy equals 3.54 (95% CI 2.56-4.91).

Conclusions: The main finding of this meta-analysis is that the prevalence of radiographic knee OA after ACL reconstruction is lower than commonly perceived. However, associated meniscal resection dramatically increases the risk for developing OA.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1007/s00167-012-2251-8DOI Listing
September 2013

The use of scaffolds in the treatment of osteochondral lesions in the knee: current concepts and future trends.

J Knee Surg 2012 Jul;25(3):179-86

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Long after the first reports on human autologous chondrocyte implantation (ACI) by Brittberg in 1994, the development of a so-called optimal technology for osteochondral tissue regeneration is still one of the most challenging issues in knee surgery. Although the short- and intermediate-term results of ACI appear to be favorable, resources are being directed toward scaffold research to improve the technology. Scaffolds used for osteochondral repair may be either cell or noncell-based before its implantation in the knee. The characteristics that make scaffolds optimal for clinical use are that they be biocompatible, biodegradable, permeable, reproducible, mechanically stable, noncytotoxic, and capable of serving as a temporary support for the cells while allowing for eventual replacement by matrix components synthesized by the implanted cells. There is a growing interest in noncell and last-minute cell seeding technologies since they allow for a one-step surgery eliminating the morbidity and necessity of a previous chondral biopsy. Although clinical and histological results from many, already clinically available scaffolds seem to be promising, improvements throughout these technologies and the developments of new ones are still necessary to obtain a more efficient biological response as well as to improve the implant's stability. Moreover, as the understanding of interactions between articular cartilage and subchondral bone continues to evolve, increased attention should be directed at treatment options for the entire osteochondral unit, rather than focusing on the articular surface only.
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http://dx.doi.org/10.1055/s-0032-1322596DOI Listing
July 2012

Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. A prospective randomised clinical trial.

Acta Orthop Belg 2012 Apr;78(2):192-8

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

We report the results of a prospective randomized clinical trial comparing the Gamma 3 nail with the ACE trochanteric nail for the treatment of pertrochanteric femoral fractures. One hundred and twelve consecutive patients were enrolled in the study: 61 patients were treated with the Gamma 3 nail, 51 with the ACE trochanteric nail. The two groups were matched for age, fracture type and preoperative Merle d'Aubigné hip score. All patients were followed up clinically and radiographically on a regular basis between 6 weeks and one year postoperatively. Twenty-six patients (23%) died within the first postoperative year. Six patients were lost to follow-up. In each group, two patients were revised due to mechanical failure. Nonunion did not occur. The mean postoperative hip scores in the Gamma 3 and the ACE group were 14.19 and 14.12 respectively, with no significant difference (p = 0.92). Walking ability was adequately restored in approximately 80% of the patients. Both implants appeared as safe and effective methods of treatment for intertrochanteric hip fractures.
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April 2012

An emerging cell-based strategy in orthopaedics: endothelial progenitor cells.

Knee Surg Sports Traumatol Arthrosc 2012 Jul 9;20(7):1366-77. Epub 2012 Mar 9.

Musculoskeletal Research Laboratory, Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, 55 Queen St. E., Suite 800, Toronto, ON, M5C 1R6, Canada.

Purpose: The purpose of this article was to analyze the results of studies in the literature, which evaluated the use of endothelial progenitor cells (EPCs) as a cell-based tissue engineering strategy.

Methods: EPCs have been successfully used in regenerative medicine to augment neovascularization in patients after myocardial infarction and limb ischemia. EPCs' important role as vasculogenic progenitors presents them as a potential source for cell-based therapies to promote bone healing.

Results: EPCs have been shown to have prominent effects in promoting bone regeneration in several animal models. Evidence indicates that EPCs promote bone regeneration by stimulating both angiogenesis and osteogenesis through a differentiation process toward endothelial cell lineage and formation of osteoblasts. Moreover, EPCs increase vascularization and osteogenesis by increased secretion of growth factors and cytokines through paracrine mechanisms.

Conclusion: EPCs offer the potential to emerge as a new strategy among other cell-based therapies to promote bone regeneration. Further investigations and human trials are required to address current questions with regard to biology and mechanisms of action of EPCs in bone tissue engineering.
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http://dx.doi.org/10.1007/s00167-012-1940-7DOI Listing
July 2012