Journal of Bone and Joint Surgery-british Volume, 2013
Background High functional aspirations and an active ageing population equate to a growing number... more Background High functional aspirations and an active ageing population equate to a growing number of patients awaiting hip arthroplasty demanding superior biomechanical function. The purpose of this study was to compare the biomechanics of top walking speed between two commonly used hip arthroplasty procedures to determine if a performance advantage existed. Methods A retrospective comparative study was performed using sixty-seven subjects, twenty-two subjects in both hip resurfacing and total hip arthroplasty groups along with twenty-three healthy controls. All arthroplasty subjects were recruited based on high psychometric scoring and had been performed through a posterior approach, and had been discharged from follow-up. On an instrumented treadmill each subject was measured by a researcher blinded to which procedure that patient had undergone. After a six minute acclimatization period, the speed was increased incrementally until top walking performance had been attained. At all ...
European Journal of Orthopaedic Surgery & Traumatology, 2005
We report an extremely rare complication of early loosening of the femoral component as a result ... more We report an extremely rare complication of early loosening of the femoral component as a result of debonding between the metal-cement interfaces presenting at 11th postoperative day. To the best of our knowledge debonding as a cause of early loosening has never been reported in literature. The postulated causes of this early debonding include either one or a combination of stem design, biomaterial and poor surgical technique. Keywords Hip prosthesis AE Loosening AE Debonding AE Surgical technique Descellement pre´coce du composant femoral d'une prothe`se de hanche
Articular hyaline cartilage damage is difficult to repair since the chondrocytes often fail to mu... more Articular hyaline cartilage damage is difficult to repair since the chondrocytes often fail to multiply in vivo. Despite many centuries of advances in medical science the repair of damaged articular cartilage tissue remains controversial. This article presents a comprehensive review of the current state of articular cartilage implantation in the knee.
European Journal of Orthopaedic Surgery and Traumatology, Jun 10, 2006
We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI).... more We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI). Seventy-three patients underwent the collagen covered ACI technique (ACI-C) and 63 patients underwent the matrix-induced autologous chondrocyte implantation technique (MACI) for symptomatic osteochondral defects of the knee, at our centre, as part of a prospective trial. The mean tourniquet time in the ACI-C group was 80.7 min (range 47-126), and 61.5 min (range 27-100) in the MACI group, P=0.003. Tourniquet times greater than 90 min were required in 22 (31%) ACI procedures and 1 (2%) MACI procedure. The reduced implantation time for the MACI procedure is a clinically significant advantage, and allows cartilage resurfacing to be performed in combination with other techniques within safe tourniquet times. Keywords Autologous chondrocyte implantation AE Tourniquet time Implantation de chondrocytes recouverts de collage`ne vs matrice autologue Re´sume´Les auteurs ont compare´les dure´es de garrot de deux techniques d'implantation de chondrocytes. 73 patients ont be´ne´ficie´d'une technique utilisant une membrane collage´nique porcine suture´e (ACI) et 63 d'une matrice collage´nique colle´e (MACI) pour le traitement de perte de substance oste´ochondrale dans le cadre d'un travail prospectif. La dure´e de garrot a e´te´en moyenne de 80,7 min (47-126) pour le groupe ACI contre 61,5 (27-100) pour le groupe MACI (P=0.003). Une dure´e de garrot supe´rieure a`90 min a e´te´ne´cessaire a`22 reprises (31%) pour la technique ACI et 1 (2%) pour le groupe MACI. La re´duction du temps d'implantation pour la technique MACI est un avantage substantiel et permet de re´aliser ce resurfac¸age cartilagineux en combinaison avec d'autres techniques en toute se´curite´quant a`la dure´e de garrot. Mots cle´s Greffe de chondrocytes autologues AE Dure´e de garrot
Introduction and Aims: Allogenic blood transfusion is often required in lower-limb arthroplasty. ... more Introduction and Aims: Allogenic blood transfusion is often required in lower-limb arthroplasty. The aims of this study were (1) to analyze the influence of anaemia on post-operative fatigue, hand grip strength, duration of in-patient physiotherapy and post-operative morbidity score (POMS) and (2) to investigate for prognostic factors to predict functional recovery following primary arthroplasty of the lower limb. Patients and methods: This study was approved by the regional ethics committee. Two hundred patients (88 THR, 99 TKR and 13 hip resurfacing) were evaluated in this prospective trial. Blood haemoglobin concentration (Hb), hand grip strength and vigour scores using a validated fatigue questionnaire were estimated both preoperatively and at 3 days following surgery. Postoperative morbidity score (POMS) and the required duration of in-patient physiotherapy were also noted. The protocol for blood transfusion was for those with Hb less than 8 g/dL and/or post-operative symptoms ...
Aims To investigate (1) The relationship between macroscopic grading and durability of cartilage ... more Aims To investigate (1) The relationship between macroscopic grading and durability of cartilage repair following collagen-covered autologous chondrocyte implantation (ACI-C) in the knee; (2) The influence of histology on durability of cartilage repair; (3) The relationship between macroscopic appearance and histology of repair tissue. Patients and methods The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up (mean follow-up = 4.7yrs. Range = 4 to 7 years). Needle biopsies of their cartilage repair site were stained with Haematoxylin and Eosin and some with Safranin O and the neo-cartilage was graded as hyaline-like (n=32, 37.2%), mixed fibro-hyaline (n=19, 22%) and fibro-cartilagenous tissue (n=35, 40.7%). Macroscopic grading of the repair tissue using the international cartilage repair society grading system (ICRS) was available for fifty-six patients in the study cohort. Statistical analyses were performe...
Introduction: Blood management in the perioperative period of the total joint arthroplasty proced... more Introduction: Blood management in the perioperative period of the total joint arthroplasty procedure has evolved over the last 3 decades. We performed two separate studies: 1) observational study to analyse surgeon’s and anaesthetist’s attitude to transfusion 2) prospective study to analyse the influence of perioperative haemoglobin concentration (Hb) on post-operative fatigue, hand grip strength, duration of in-patient physiotherapy and post-operative morbidity score (POMS) and also the prognostic factors to predict functional recovery. Method: 500 orthopaedic surgeons and 336 anaesthetists were surveyed to assess current UK attitudes towards transfusion practice following arthroplasty. 200 patients (88 THR, 99 TKR, 13 hip resurfacing) were evaluated. Blood Hb, hand grip strength and vigour scores using fatigue questionnaire were estimated both preoperatively and at 3 days following surgery. POMS and the required duration of in-patient physiotherapy were also noted. The protocol fo...
In 1953, Seldinger first described a technique for percutaneous cannulation of a blood vessels. T... more In 1953, Seldinger first described a technique for percutaneous cannulation of a blood vessels. This was achieved by placing a guide wire through a hollow needle; the blood vessel lumen was then accessed along the guide wire. We believe that end capping of intramedullary nails can be reliably achieved using a combination of our described 'Seldinger' technique using a guide wire and trocar and conventional image intensification.
Aim: The aim of this study was to correlate the histology of cartilage repair site with long term... more Aim: The aim of this study was to correlate the histology of cartilage repair site with long term clinical function. Materials and methods: We have analyzed the clinical results of a cohort of patients who had collagen-covered autologous chondrocyte implantations performed since 1998. Our hypothesis was that the hyaline cartilage repair does influence the clinical outcome. The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up following ACI-C (mean follow-up= 4.7 years. Range= 4 to 7 years). All these patients underwent biopsies of their cartilage repair site performed at variable periods between six months and five years following ACI-C (mean=22.2 months). The neo-cartilage was graded as hyaline (n=32), mixed fibrohyaline (n=19), fibrocartilagenous (n=35) and fibrous (n=0). Results: The clinical results showed that at one year, the percentage of patients with excellent and good results was 84.4, 89.5 and 74.3 respectively for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous histology respectively. Their mean MCRS were 70.8, 72.4 and 66.2 respectively. This difference was not statistically significant (p=0.34). However, their clinical scores at the latest follow-up demonstrated a significantly superior result for those with hyaline repair tissue when compared to those with mixed fibro-hyaline and fibro-cartilagenous repair tissue (p=0.05). The percentage of patients with excellent and good results for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous repair was 75, 42 and 68.6 respectively. Their mean MCRS were 70.6, 56.8 and 63.9 respectively. Conclusion: This study demonstrates that any form of cartilage repair would give good clinical outcome at one year. At four years and beyond, it appears that patients with hyaline repair tissue tend to show a more favourable clinical outcome whereas those who demonstrated mixed fibrohyaline and fibrocartilagenous repair would show less favourable clinical results.
The Journal of Bone and Joint Surgery. British volume, 2006
We investigated the prognostic indicators for collagen-covered autologous chondrocyte implantatio... more We investigated the prognostic indicators for collagen-covered autologous chondrocyte implantation (ACI-C) performed for symptomatic osteochondral defects of the knee. We analysed prospectively 199 patients for up to four years after surgery using the modified Cincinnati score. Arthroscopic assessment and biopsy of the neocartilage was also performed whenever possible. The favourable factors for ACI-C include younger patients with higher pre-operative modified Cincinnati scores, a less than two-year history of symptoms, a single defect, a defect on the trochlea or lateral femoral condyle and patients with fewer than two previous procedures on the index knee. Revision ACI-C in patients with previous ACI and mosaicplasties which had failed produced significantly inferior clinical results. Gender (p = 0.20) and the size of the defect (p = 0.97) did not significantly influence the outcome.
The Journal of Bone and Joint Surgery. British volume, 2005
Autologous chondrocyte implantation (ACI) is used widely as a treatment for symptomatic chondral ... more Autologous chondrocyte implantation (ACI) is used widely as a treatment for symptomatic chondral and osteochondral defects of the knee. Variations of the original periosteum-cover technique include the use of porcine-derived type I/type III collagen as a cover (ACI-C) and matrix-induced autologous chondrocyte implantation (MACI) using a collagen bilayer seeded with chondrocytes. We have performed a prospective, randomised comparison of ACI-C and MACI for the treatment of symptomatic chondral defects of the knee in 91 patients, of whom 44 received ACI-C and 47 MACI grafts. Both treatments resulted in improvement of the clinical score after one year. The mean modified Cincinnati knee score increased by 17.6 in the ACI-C group and 19.6 in the MACI group (p = 0.32). Arthroscopic assessments performed after one year showed a good to excellent International Cartilage Repair Society score in 79.2% of ACI-C and 66.6% of MACI grafts. Hyaline-like cartilage or hyaline-like cartilage with fibr...
Journal of Bone and Joint Surgery - British Volume, 2006
We prospectively studied the clinical, arthroscopic and histological results of collagen-covered ... more We prospectively studied the clinical, arthroscopic and histological results of collagen-covered autologous chondrocyte implantation (ACI-C) in patients with symptomatic osteochondritis dissecans of the knee. The study included 37 patients who were evaluated at a mean follow-up of 4.08 years. Clinical results showed a mean improvement in the modified Cincinnati score from 46.1 to 68.4. Excellent and good clinical results were seen in 82.1% of those with juvenile-onset osteochondritis dissecans but in only 44.4% of those with adult-onset disease. Arthroscopy at one year revealed International Cartilage Repair Society grades of 1 or 2 in 21 of 24 patients (87.5%). Of 23 biopsies, 11 (47.8%) showed either a hyaline-like or a mixture of hyaline-like and fibrocartilage, 12 (52.2%) showed fibrocartilage. The age at the time of ACI-C determined the clinical outcome for juvenile-onset disease (p = 0.05), whereas the size of the defect was the major determinant of outcome in adult-onset dise...
This study defines normal bilateral variations in offset and hip center location on pelvic radiog... more This study defines normal bilateral variations in offset and hip center location on pelvic radiographs. The relationship of the femoral head center to the tip of the greater trochanter and that of offset to medullary canal diameter are also defined. Measurements of the offset, hip center location, height of the tip of the greater trochanter from the femoral head center, and medullary canal diameter were carried out on 100 normal pelvic radiographs. The offset of one hip was found to predict that of the contralateral hip to within 4.62 mm with 95% confidence. Their hip center locations differed by 6.3 mm. The tip of the greater trochanter was, on average, 8 mm higher than the femoral head center. Although offset generally increased with an increase in medullary canal diameter, frequent discrepancies occurred in their relationship.
European Journal of Orthopaedic Surgery & Traumatology, 2006
We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI).... more We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI). Seventy-three patients underwent the collagen covered ACI technique (ACI-C) and 63 patients underwent the matrix-induced autologous chondrocyte implantation technique (MACI) for symptomatic osteochondral defects of the knee, at our centre, as part of a prospective trial. The mean tourniquet time in the ACI-C group was 80.7 min (range 47-126), and 61.5 min (range 27-100) in the MACI group, P=0.003. Tourniquet times greater than 90 min were required in 22 (31%) ACI procedures and 1 (2%) MACI procedure. The reduced implantation time for the MACI procedure is a clinically significant advantage, and allows cartilage resurfacing to be performed in combination with other techniques within safe tourniquet times. Autologous chondrocyte implantation AE Tourniquet time Implantation de chondrocytes recouverts de collage`ne vs matrice autologue Re´sume´Les auteurs ont compare´les dure´es de garrot de deux techniques d'implantation de chondrocytes. 73 patients ont be´ne´ficie´d'une technique utilisant une membrane collage´nique porcine suture´e (ACI) et 63 d'une matrice collage´nique colle´e (MACI) pour le traitement de perte de substance oste´ochondrale dans le cadre d'un travail prospectif. La dure´e de garrot a e´te´en moyenne de 80,7 min (47-126) pour le groupe ACI contre 61,5 (27-100) pour le groupe MACI (P=0.003). Une dure´e de garrot supe´rieure a`90 min a e´te´ne´cessaire a`22 reprises (31%) pour la technique ACI et 1 (2%) pour le groupe MACI. La re´duction du temps d'implantation pour la technique MACI est un avantage substantiel et permet de re´aliser ce resurfac¸age cartilagineux en combinaison avec d'autres techniques en toute se´curite´quant a`la dure´e de garrot.
Journal of Bone and Joint Surgery-british Volume, 2013
Background High functional aspirations and an active ageing population equate to a growing number... more Background High functional aspirations and an active ageing population equate to a growing number of patients awaiting hip arthroplasty demanding superior biomechanical function. The purpose of this study was to compare the biomechanics of top walking speed between two commonly used hip arthroplasty procedures to determine if a performance advantage existed. Methods A retrospective comparative study was performed using sixty-seven subjects, twenty-two subjects in both hip resurfacing and total hip arthroplasty groups along with twenty-three healthy controls. All arthroplasty subjects were recruited based on high psychometric scoring and had been performed through a posterior approach, and had been discharged from follow-up. On an instrumented treadmill each subject was measured by a researcher blinded to which procedure that patient had undergone. After a six minute acclimatization period, the speed was increased incrementally until top walking performance had been attained. At all ...
European Journal of Orthopaedic Surgery & Traumatology, 2005
We report an extremely rare complication of early loosening of the femoral component as a result ... more We report an extremely rare complication of early loosening of the femoral component as a result of debonding between the metal-cement interfaces presenting at 11th postoperative day. To the best of our knowledge debonding as a cause of early loosening has never been reported in literature. The postulated causes of this early debonding include either one or a combination of stem design, biomaterial and poor surgical technique. Keywords Hip prosthesis AE Loosening AE Debonding AE Surgical technique Descellement pre´coce du composant femoral d'une prothe`se de hanche
Articular hyaline cartilage damage is difficult to repair since the chondrocytes often fail to mu... more Articular hyaline cartilage damage is difficult to repair since the chondrocytes often fail to multiply in vivo. Despite many centuries of advances in medical science the repair of damaged articular cartilage tissue remains controversial. This article presents a comprehensive review of the current state of articular cartilage implantation in the knee.
European Journal of Orthopaedic Surgery and Traumatology, Jun 10, 2006
We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI).... more We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI). Seventy-three patients underwent the collagen covered ACI technique (ACI-C) and 63 patients underwent the matrix-induced autologous chondrocyte implantation technique (MACI) for symptomatic osteochondral defects of the knee, at our centre, as part of a prospective trial. The mean tourniquet time in the ACI-C group was 80.7 min (range 47-126), and 61.5 min (range 27-100) in the MACI group, P=0.003. Tourniquet times greater than 90 min were required in 22 (31%) ACI procedures and 1 (2%) MACI procedure. The reduced implantation time for the MACI procedure is a clinically significant advantage, and allows cartilage resurfacing to be performed in combination with other techniques within safe tourniquet times. Keywords Autologous chondrocyte implantation AE Tourniquet time Implantation de chondrocytes recouverts de collage`ne vs matrice autologue Re´sume´Les auteurs ont compare´les dure´es de garrot de deux techniques d'implantation de chondrocytes. 73 patients ont be´ne´ficie´d'une technique utilisant une membrane collage´nique porcine suture´e (ACI) et 63 d'une matrice collage´nique colle´e (MACI) pour le traitement de perte de substance oste´ochondrale dans le cadre d'un travail prospectif. La dure´e de garrot a e´te´en moyenne de 80,7 min (47-126) pour le groupe ACI contre 61,5 (27-100) pour le groupe MACI (P=0.003). Une dure´e de garrot supe´rieure a`90 min a e´te´ne´cessaire a`22 reprises (31%) pour la technique ACI et 1 (2%) pour le groupe MACI. La re´duction du temps d'implantation pour la technique MACI est un avantage substantiel et permet de re´aliser ce resurfac¸age cartilagineux en combinaison avec d'autres techniques en toute se´curite´quant a`la dure´e de garrot. Mots cle´s Greffe de chondrocytes autologues AE Dure´e de garrot
Introduction and Aims: Allogenic blood transfusion is often required in lower-limb arthroplasty. ... more Introduction and Aims: Allogenic blood transfusion is often required in lower-limb arthroplasty. The aims of this study were (1) to analyze the influence of anaemia on post-operative fatigue, hand grip strength, duration of in-patient physiotherapy and post-operative morbidity score (POMS) and (2) to investigate for prognostic factors to predict functional recovery following primary arthroplasty of the lower limb. Patients and methods: This study was approved by the regional ethics committee. Two hundred patients (88 THR, 99 TKR and 13 hip resurfacing) were evaluated in this prospective trial. Blood haemoglobin concentration (Hb), hand grip strength and vigour scores using a validated fatigue questionnaire were estimated both preoperatively and at 3 days following surgery. Postoperative morbidity score (POMS) and the required duration of in-patient physiotherapy were also noted. The protocol for blood transfusion was for those with Hb less than 8 g/dL and/or post-operative symptoms ...
Aims To investigate (1) The relationship between macroscopic grading and durability of cartilage ... more Aims To investigate (1) The relationship between macroscopic grading and durability of cartilage repair following collagen-covered autologous chondrocyte implantation (ACI-C) in the knee; (2) The influence of histology on durability of cartilage repair; (3) The relationship between macroscopic appearance and histology of repair tissue. Patients and methods The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up (mean follow-up = 4.7yrs. Range = 4 to 7 years). Needle biopsies of their cartilage repair site were stained with Haematoxylin and Eosin and some with Safranin O and the neo-cartilage was graded as hyaline-like (n=32, 37.2%), mixed fibro-hyaline (n=19, 22%) and fibro-cartilagenous tissue (n=35, 40.7%). Macroscopic grading of the repair tissue using the international cartilage repair society grading system (ICRS) was available for fifty-six patients in the study cohort. Statistical analyses were performe...
Introduction: Blood management in the perioperative period of the total joint arthroplasty proced... more Introduction: Blood management in the perioperative period of the total joint arthroplasty procedure has evolved over the last 3 decades. We performed two separate studies: 1) observational study to analyse surgeon’s and anaesthetist’s attitude to transfusion 2) prospective study to analyse the influence of perioperative haemoglobin concentration (Hb) on post-operative fatigue, hand grip strength, duration of in-patient physiotherapy and post-operative morbidity score (POMS) and also the prognostic factors to predict functional recovery. Method: 500 orthopaedic surgeons and 336 anaesthetists were surveyed to assess current UK attitudes towards transfusion practice following arthroplasty. 200 patients (88 THR, 99 TKR, 13 hip resurfacing) were evaluated. Blood Hb, hand grip strength and vigour scores using fatigue questionnaire were estimated both preoperatively and at 3 days following surgery. POMS and the required duration of in-patient physiotherapy were also noted. The protocol fo...
In 1953, Seldinger first described a technique for percutaneous cannulation of a blood vessels. T... more In 1953, Seldinger first described a technique for percutaneous cannulation of a blood vessels. This was achieved by placing a guide wire through a hollow needle; the blood vessel lumen was then accessed along the guide wire. We believe that end capping of intramedullary nails can be reliably achieved using a combination of our described 'Seldinger' technique using a guide wire and trocar and conventional image intensification.
Aim: The aim of this study was to correlate the histology of cartilage repair site with long term... more Aim: The aim of this study was to correlate the histology of cartilage repair site with long term clinical function. Materials and methods: We have analyzed the clinical results of a cohort of patients who had collagen-covered autologous chondrocyte implantations performed since 1998. Our hypothesis was that the hyaline cartilage repair does influence the clinical outcome. The modified Cincinnati scores (MCRS) of eighty-six patients were evaluated prospectively at one year and at the latest follow-up following ACI-C (mean follow-up= 4.7 years. Range= 4 to 7 years). All these patients underwent biopsies of their cartilage repair site performed at variable periods between six months and five years following ACI-C (mean=22.2 months). The neo-cartilage was graded as hyaline (n=32), mixed fibrohyaline (n=19), fibrocartilagenous (n=35) and fibrous (n=0). Results: The clinical results showed that at one year, the percentage of patients with excellent and good results was 84.4, 89.5 and 74.3 respectively for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous histology respectively. Their mean MCRS were 70.8, 72.4 and 66.2 respectively. This difference was not statistically significant (p=0.34). However, their clinical scores at the latest follow-up demonstrated a significantly superior result for those with hyaline repair tissue when compared to those with mixed fibro-hyaline and fibro-cartilagenous repair tissue (p=0.05). The percentage of patients with excellent and good results for those with hyaline, mixed fibro-hyaline and fibro-cartilagenous repair was 75, 42 and 68.6 respectively. Their mean MCRS were 70.6, 56.8 and 63.9 respectively. Conclusion: This study demonstrates that any form of cartilage repair would give good clinical outcome at one year. At four years and beyond, it appears that patients with hyaline repair tissue tend to show a more favourable clinical outcome whereas those who demonstrated mixed fibrohyaline and fibrocartilagenous repair would show less favourable clinical results.
The Journal of Bone and Joint Surgery. British volume, 2006
We investigated the prognostic indicators for collagen-covered autologous chondrocyte implantatio... more We investigated the prognostic indicators for collagen-covered autologous chondrocyte implantation (ACI-C) performed for symptomatic osteochondral defects of the knee. We analysed prospectively 199 patients for up to four years after surgery using the modified Cincinnati score. Arthroscopic assessment and biopsy of the neocartilage was also performed whenever possible. The favourable factors for ACI-C include younger patients with higher pre-operative modified Cincinnati scores, a less than two-year history of symptoms, a single defect, a defect on the trochlea or lateral femoral condyle and patients with fewer than two previous procedures on the index knee. Revision ACI-C in patients with previous ACI and mosaicplasties which had failed produced significantly inferior clinical results. Gender (p = 0.20) and the size of the defect (p = 0.97) did not significantly influence the outcome.
The Journal of Bone and Joint Surgery. British volume, 2005
Autologous chondrocyte implantation (ACI) is used widely as a treatment for symptomatic chondral ... more Autologous chondrocyte implantation (ACI) is used widely as a treatment for symptomatic chondral and osteochondral defects of the knee. Variations of the original periosteum-cover technique include the use of porcine-derived type I/type III collagen as a cover (ACI-C) and matrix-induced autologous chondrocyte implantation (MACI) using a collagen bilayer seeded with chondrocytes. We have performed a prospective, randomised comparison of ACI-C and MACI for the treatment of symptomatic chondral defects of the knee in 91 patients, of whom 44 received ACI-C and 47 MACI grafts. Both treatments resulted in improvement of the clinical score after one year. The mean modified Cincinnati knee score increased by 17.6 in the ACI-C group and 19.6 in the MACI group (p = 0.32). Arthroscopic assessments performed after one year showed a good to excellent International Cartilage Repair Society score in 79.2% of ACI-C and 66.6% of MACI grafts. Hyaline-like cartilage or hyaline-like cartilage with fibr...
Journal of Bone and Joint Surgery - British Volume, 2006
We prospectively studied the clinical, arthroscopic and histological results of collagen-covered ... more We prospectively studied the clinical, arthroscopic and histological results of collagen-covered autologous chondrocyte implantation (ACI-C) in patients with symptomatic osteochondritis dissecans of the knee. The study included 37 patients who were evaluated at a mean follow-up of 4.08 years. Clinical results showed a mean improvement in the modified Cincinnati score from 46.1 to 68.4. Excellent and good clinical results were seen in 82.1% of those with juvenile-onset osteochondritis dissecans but in only 44.4% of those with adult-onset disease. Arthroscopy at one year revealed International Cartilage Repair Society grades of 1 or 2 in 21 of 24 patients (87.5%). Of 23 biopsies, 11 (47.8%) showed either a hyaline-like or a mixture of hyaline-like and fibrocartilage, 12 (52.2%) showed fibrocartilage. The age at the time of ACI-C determined the clinical outcome for juvenile-onset disease (p = 0.05), whereas the size of the defect was the major determinant of outcome in adult-onset dise...
This study defines normal bilateral variations in offset and hip center location on pelvic radiog... more This study defines normal bilateral variations in offset and hip center location on pelvic radiographs. The relationship of the femoral head center to the tip of the greater trochanter and that of offset to medullary canal diameter are also defined. Measurements of the offset, hip center location, height of the tip of the greater trochanter from the femoral head center, and medullary canal diameter were carried out on 100 normal pelvic radiographs. The offset of one hip was found to predict that of the contralateral hip to within 4.62 mm with 95% confidence. Their hip center locations differed by 6.3 mm. The tip of the greater trochanter was, on average, 8 mm higher than the femoral head center. Although offset generally increased with an increase in medullary canal diameter, frequent discrepancies occurred in their relationship.
European Journal of Orthopaedic Surgery & Traumatology, 2006
We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI).... more We have compared tourniquet times of two techniques of autologous chondrocyte implantation (ACI). Seventy-three patients underwent the collagen covered ACI technique (ACI-C) and 63 patients underwent the matrix-induced autologous chondrocyte implantation technique (MACI) for symptomatic osteochondral defects of the knee, at our centre, as part of a prospective trial. The mean tourniquet time in the ACI-C group was 80.7 min (range 47-126), and 61.5 min (range 27-100) in the MACI group, P=0.003. Tourniquet times greater than 90 min were required in 22 (31%) ACI procedures and 1 (2%) MACI procedure. The reduced implantation time for the MACI procedure is a clinically significant advantage, and allows cartilage resurfacing to be performed in combination with other techniques within safe tourniquet times. Autologous chondrocyte implantation AE Tourniquet time Implantation de chondrocytes recouverts de collage`ne vs matrice autologue Re´sume´Les auteurs ont compare´les dure´es de garrot de deux techniques d'implantation de chondrocytes. 73 patients ont be´ne´ficie´d'une technique utilisant une membrane collage´nique porcine suture´e (ACI) et 63 d'une matrice collage´nique colle´e (MACI) pour le traitement de perte de substance oste´ochondrale dans le cadre d'un travail prospectif. La dure´e de garrot a e´te´en moyenne de 80,7 min (47-126) pour le groupe ACI contre 61,5 (27-100) pour le groupe MACI (P=0.003). Une dure´e de garrot supe´rieure a`90 min a e´te´ne´cessaire a`22 reprises (31%) pour la technique ACI et 1 (2%) pour le groupe MACI. La re´duction du temps d'implantation pour la technique MACI est un avantage substantiel et permet de re´aliser ce resurfac¸age cartilagineux en combinaison avec d'autres techniques en toute se´curite´quant a`la dure´e de garrot.
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