Introduction: Incomplete removal of calcified cartilage appears to be associated with suboptimal repair tissue attachment. Furthermore, histologic evaluation of arthroscopically debrided chondral lesions demonstrated that removal of calcified cartilage was not obvious using standard arthroscopic equipment. The purpose of this study was to compare chondral healing with and without removal of calcified cartilage in experimentally created chondral defects. Methods: Twelve mature horses underwent bilateral arthroscopy of the femorotibial joints. A 1cm2 chondral lesion was made on the weight bearing surface of both medial femoral condyles. Randomly, in each horse one lesion had complete removal of the calcified cartilage layer (CCL) using curettes, and the CCL was left intact on the contralateral side. All defects were subjected to subchondral bone microfracture. At 12 months, all horses were euthanized and all femorotibial joints were harvested. MR imaging was performed in a 1.5 Tesla clinical MRI scanner. Analysis of variance was to analyze data. Results: Gross and histomorphometric observations confirmed significantly (p Conclusions: Based on gross, MRI and histologic findings, this study suggests that care should be taken in debridement of clinical cartilage lesions to assure complete removal of calcified cartilage. Summary: Removal of the calcified cartilage layer significantly improves the healing of chondral defects.

Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses

Instructive cartilage regeneration modalities with advanced therapeutic implantations under abnormal conditions.

Chondral defects of the knee are common and their treatment is challenging.PubMed, Google scholar, Embase and Scopus databases.Both autologous matrix-induced chondrogenesis (AMIC) and membrane-induced autologous chondrocyte implantation (mACI) have been used to manage chondral defects of the knee.It is debated whether AMIC and mACI provide equivalent outcomes for the management of chondral defects in the knee at midterm follow-up. Despite the large number of clinical studies, the optimal treatment is still controversial.To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up.AMIC may provide better outcomes than mACI for chondral defects of the knee. Further studies are required to verify these results in a clinical setting. 

OUP accepted manuscript

OBJECTIVE. The purpose of this study was to describe the epidemiology and imaging characteristics of cervical spine injuries in children with blunt trauma. MATERIALS AND METHODS. We conducted a retrospective review of the records of all patients 16 years old or younger with a diagnosis of cervical spine injury in the trauma registry of our level 1 trauma center between July 2006 and June 2018. RESULTS. Two hundred thirty-five patients were included in the study: 125 with subaxial cervical spine injuries, 87 with upper cervical spine injuries, and 23 with both subaxial and upper cervical spine injuries. The frequency of isolated upper cervical spine injuries was 73% in patients younger than 3 years old, 48% in patients 3-8 years old, and 29% in patients older than 8 years old. Seventy-one percent of occipital condyle fractures were avulsions, and 26% of dens fractures were avulsions. Type II dens fractures were found only in patients older than 8 years old. Type I and III dens fractures were almost exclusively in patients 8 years old or younger. Injuries classified as AOSpine types A, B, and C comprised 65.6%, 17.2%, and 17.2% of subaxial injuries, respectively. Despite similar mechanism of injury distribution across age groups, the frequency of AOSpine type A injuries in patients older than 8 years old (70.6%) was significantly higher compared with patients younger than 3 years old (40.0%) and those who were 3-8 years old (45.0%). The frequency of AOSpine type B injuries in patients younger than 3 years old (40.0%) was slightly higher than patients who were 3-8 years old (30.0%) and almost three times higher than in patients older than 8 years old (13.8%). CONCLUSION. Pediatric patients have high rates of upper cervical spine injuries, which tend to be distraction injuries that are frequently associated with avulsion fractures. Injury patterns in pediatric patients vary significantly by age, with patients younger than 3 years old being particularly prone to distraction type injuries.

https://www.ajronline.org/doi/pdf/10.2214/AJR.19.22095

Epidemiology and Imaging Classification of Pediatric Cervical Spine Injuries: 12-Year Experience at a Level 1 Trauma Center.

Joint repair remains a major challenge in orthopaedics. Recent progress in biomaterial design has led to the fabrication of a plethora of promising devices. Pre-clinical testing of any joint repair strategy typically requires the use of large animal models (e.g., sheep, goat, pig or horse). Despite the key role of such models in clinical translation, there is still a lack of consensus regarding optimal experimental design, making it difficult to draw conclusions on their efficacy. In this context, the authors performed a systematic literature review and a risk of bias assessment on large animal models published between 2010 and 2020, to identify key experimental parameters that significantly affect the biomaterial therapeutic outcome and clinical translation potential (including defect localization, animal age/maturity, selection of controls, cell-free versus cell-laden). They determined that mechanically strong biomaterials perform better at the femoral condyles; while highlighted the importance of including native tissue controls to better evaluate the quality of the newly formed tissue. Finally, in cell-laded biomaterials, the pre-culture conditions played a more important role in defect repair than the cell type. In summary, here they present a systematic evaluation on how the experimental design of preclinical models influences biomaterial-based therapeutic outcomes in joint repair.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/adhm.202100878

Systematic Comparison of Biomaterials-Based Strategies for Osteochondral and Chondral Repair in Large Animal Models.

The treatment of articular cartilage damage is a major clinical problem. More often, this clinical issue affects children, which forces doctors to find the best treatment method. The aim of this experimental study on 2-month-old Landrace pigs was to compare the results of two cartilage defect treatments: (1) filling the cartilage defect with a scaffold incubated with bone marrow aspirate supplemented with growth plate chondrocytes (the CELLS group) and (2) filling the cartilage defect with an empty scaffold implanted after drilling the subchondral bone (the CTRL group). The treatment outcomes were assessed macroscopically and microscopically. Based on the macroscopic evaluation, all animals showed a nearly normal morphology, with an average of 9.66/12 points (CTRL) and 10.44/12 points (CELLS). Based on the microscopic evaluation, 1 very good result and 8 good results were obtained in the CTRL group, with an average of 70.44%, while 5 very good results and 4 good results were obtained in the CELLS group, with an average of 79.61%. (1) Growth plate chondrocytes have high chondrogenic potential and thus offer new possibilities for cartilage cell therapy. (2) The implantation of a scaffold loaded with bone marrow-derived MSCs (mesenchymal stem cells) and growth plate chondrocytes into a cartilage defect is a good therapeutic method in immature patients. (3) Cartilage repair based on a scaffold with bone marrow aspirate-derived cells supplemented with autologous growth plate chondrocytes achieves better results than repair with marrow stimulation and a hyaluronic acid-based scaffold (overall microscopic rating). (4) Chondrocyte clustering is a manifestation of the cartilage repair process but requires further observation.

/pdf/enhancement-of-cartilage-repair-through-the-addition-of-m5sor97hyd.pdf

Enhancement of cartilage repair through the addition of growth plate chondrocytes in an immature skeleton animal model

Background Occipital condyle fractures are rare injuries of the cranio-cervical junction seen more often in adults than in children. They are best diagnosed with CT of the cranio-cervical junction. Treatment depends on the morphology and stability of the fracture. The aim of the present paper was to present cases of occipital condyle fractures treated at our Department, review the literature, and stress the importance of MRI studies in the diagnostic work-up of these injuries. Material and methods Our retrospective study involved a group of 3 female patients (mean age was 16.3 years) with occipital condyle fractures diagnosed/treated at our Department. We assessed the cause and type of fracture, additional damage, available classification systems, treatment methods, outcomes and complications. Results Mean follow-up period was 16 (10-22) months. We achieved good clinical outcomes (NDI scores) in all the patients. In one patient, a follow-up MRI scan revealed the presence of a clinically silent post-traumatic epidural meningeal cyst at the C2-C6 level, anterior to the spinal cord. Conclusions CT of the cranio-cervical junction is the best method of diagnosing occipital condyle fractures. 2. The choice of an appropriate treatment method is decisively based on the assessment of the morphology and stability of the fracture in a CT/MRI scan rather than on the fracture type alone. 3. There is no noticeable difference between the usefulness of the classification system developed by Anderson and Montesano and that according to Tuli et al. 4. In our opinion, the system of occipital condyle fracture classification proposed in 2012 does not seem superior in everyday clinical practice. 5. The use of the halo-vest is a good method of treating unstable occipital condyle fractures. 6. Early diagnosis and appropriate treatment of cranio-cervical junction fractures make it possible for the fracture to heal without severe clinical sequelae.

Occipital Condyle Fractures in Adolescents.

(1) Background: Anterior cruciate ligament avulsion fractures are characteristic for skeletally immature patients, and appropriate treatment is currently debated in the literature. The study aimed to evaluate the clinical and functional outcomes in patients with tibial eminence fractures treated with bioabsorbable nails in one orthopedic clinic. (2) Methods: After retrospective evaluation, we found 17 patients with tibial eminence fractures treated in orthopedic departments between January 2013 and July 2022 using bioabsorbable fixation nails. The study group comprised 12 boys and five girls aged 5 to 15.2 (average 10.1). The mean follow-up was 28 months. We diagnosed five type II fractures, ten type III fractures, and two type IV fractures according to Meyers–McKeever classification. (3) Results: We obtained a high healing rate—17 patients with the complete union on the control radiographs. We diagnosed two cases of malunion, of which one required revision surgery. Only one patient showed a slight anterior knee laxity. The treatment effect at follow-up was assessed using the Lysholm Knee Score and IKDC Score. The median Lysholm Score was 96.64 (SD 4.54), and the median IKDC Score was 84.64 (SD 3.10), which were both excellent results. (4) Conclusions: Based on our results, surgery using bioabsorbable devices for type II, III, and IV tibial eminence fractures in young individuals is an effective alternative, allowing good outcomes and restoring proper knee stability. The crucial factor for a good effect is a stable fracture fixation. Arthroscopic surgery gives good outcomes with minimal invasion. It is important not to prolong the attempts of arthroscopic reduction and to perform the open reduction to shorten the procedure’s time and avoid complications.

/pdf/results-of-anterior-cruciate-ligament-avulsion-fracture-by-2kywjxjy.pdf

Results of Anterior Cruciate Ligament Avulsion Fracture by Treatment Using Bioabsorbable Nails in Children and Adolescents

(1) Background: This is the first systematic review concerning the treatment of osteochondritis dissecans with the use of bioabsorbable implants. The study was done as a comprehensive review to identify important factors affecting the results of OCD treatment in children and adolescents; (2) Methods: We searched electronic bibliographic databases including PubMed, Cochrane Library, Scopus, and Web of Knowledge until May 2022. This systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PICO (Patients, Interventions, Comparisons, Outcomes) guidelines; (3) Results: We identified 2662 original papers of which 11 were found to be eligible for further analysis. The study group included a total of 164 OCD lesions in 158 patients. In 94.86% of postoperative cases, there was complete healing or local improvement on follow-up CT or MRI scans. The great majority of patients achieved a good clinical effect. Out of 164 OCD lesions, 10 did not heal (6.09%); (4) Conclusions: Surgical treatment of stable and unstable OCD in children with the use of bioabsorbable implants facilitates a high rate of healing and a good clinical outcome; treatment of juvenile OCD is associated with a better outcome compared to adult OCD; the use of bioabsorbable implants for the treatment of humeral capitellum OCD is associated with a more frequent incidence of synovitis (18.2%).

https://www.mdpi.com/2077-0383/11/18/5395/pdf?version=1663152423

Evaluation of Osteochondritis Dissecans Treatment with Bioabsorbable Implants in Children and Adolescents

Evaluation of thoracic vertebrae rotation in patients with pectus excavatum.

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