Arthroscopic Repair of Bucket Handle Medial Meniscal Tear

Sachin Tapasvi

Volume 4 | Issue 1 | Jan – April 2019 | Page 2-3

Author: Sachin Tapasvi[1]

[1] Orthopaedic Speciality Clinic, Pune Mahatrahtra.

Address of Correspondence
Dr Sachin Tapasvi
Orthopaedic Speciality Clinic, Pune Mahatrahtra.
Email: stapasvi@gmail.com

Abstract

19-year-old female dancer presented with pain and locking with no instability. She walked with antalgic gait with rom of 10 degrees to 130 degrees. The anterior drawers were grade 1 with the firm endpoint and Mcmurray’s test was positive. A previous surgery in the form of transportal ACL reconstruction was done. MRI revealed a bucket handle tear of the medial meniscus. This video demonstrates the Outside In technique of meniscal repair of the bucket handle tear

How to Cite this article: Tapasvi S. Arthroscopic Repair of Bucket Handle Medial Meniscal Tear. Asian Journal of Arthroscopy Jan – April 2019;4(1):38

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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis

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The Microfracture Technique: Pearls and Pitfalls

Devin P. Leland, Christopher D. Bernard, Aaron J. Krych

Volume 4 | Issue 1 | Jan – April 2019 | Page 4- 14

Author: Devin P. Leland[1], Christopher D. Bernard[1], Aaron J. Krych[1*]

From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.

Address of Correspondence
Dr. Aaron J. Krych, MD
Mayo Clinic, 200 First Street SW, Rochester, MN 55905
Email: Krych.Aaron@Mayo.edu

Abstract

Preservation of articular cartilage is essential for appropriate health and function of the knee. Chondral lesions have therefore been identified as a common cause of knee pain and morbidity. For many years, the microfracture technique has offered a simple and minimally invasive procedure for the treatment of isolated articular cartilage lesions. Identifying patients who are appropriate for microfracture is difficult and requires careful selection. Younger patients (<35 years of age) with smaller lesions (<2 cm2) who are non-obese have demonstrated the greatest improvement following microfracture, especially in the short-term (<24 months). However, long-term outcomes are less promising and advanced cartilage restoration techniques such as osteochondral grafting or chondrocyte implantation have been developed. As a result, the focus of current research is centered on comparing microfracture to these more novel techniques to determine which procedure(s) offer superior long-term results. Ultimately, the orthopedist’s goal has not changed since originally implementing the microfracture procedure: to provide patients with full-thickness isolated chondral defects the best available treatment for long-term preservation of knee function and biomechanics.

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How to Cite this article: Leland DP, Bernard CD, Krych AJ. The Microfracture Technique: Pearls and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1):9-14

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HA-BMAC: The Surgical Technique, Pearls and Pitfalls

Katarzyna Herman, Vetri Kumar, Dawid Szwedowski, Luca Chierici, Alberto Gobbi

Volume 4 | Issue 1 | Jan – April 2019 | Page 34- 37

Author: Katarzyna Herman[1], Vetri Kumar[1], Dawid Szwedowski[1], Luca Chierici[1], Alberto Gobbi[1]

Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy.

Address of Correspondence
Dr.Alberto Gobbi, MD
Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Via G.A. Amadeo 24, 20133, Milan, Italy.
Email: gobbi@cartilagedoctor.it

Abstract

Articular cartilage is a highly specialized tissue with poor healing potential. Damage to the cartilage following an injury to the joint is prevalent which leads to osteoarthritis. More research is aimed towards tissue regeneration and prevention of degeneration. Efforts to repair and restore the hyaline like cartilage using two-stage procedures such as autologous chondrocyte implantation have led to the development of scaffolds. Bone marrow aspirate concentrate that contains multi potent stem cells which has the potential to differentiate into hyaline like cartilage along with the use of a scaffold is an effective, reliable and single-stage method of cartilage restoration

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How to Cite this article: Herman K, Kumar V, Szwedowski D, Chierici L, Gobbi A. HA-BMAC: The Surgical Technique, Pearls and Pitfalls . Asian Journal Arthroscopy. Jan-April 2019;4(1):34-37

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Gel Based Autologous Chondrocyte Implantation: The Surgical Technique

Deepak Goyal, Vishvas Modi

Volume 4 | Issue 1 | Jan – April 2019 | Page 27- 33

Author: Deepak Goyal[1], Vishvas Modi[1]

Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.

Address of Correspondence
Dr (Prof) Deepak Goyal
Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.
Email: deepak@knee.in

Abstract

Autologous chondrocyte implantation (ACI) is one such technique that has the ability to provide a hyaline (like) repair of the localized cartilage lesions, even when they are of a big size. However, the procedure must be chosen very wisely because of its stringent indications and contraindications. Decision to do ACI procedure is very crucial and the surgeon must come to the decision after a detailed clinic-radiological examination. Gel based ACI is one such technique that allows a 3-dimensional distribution of the autologous cultured chondrocytes in a scaffold that is made of fibrin glue. The technique takes away the common complications that were associated with 1st and 2nd generation ACI; like graft hypertrophy, poor access to the lesion, membrane suturing, monolayer distribution etc. The purpose of this paper is to discuss the indications, contraindications, decision making and preoperative planning for the gel based autologous chondrocyte implantation technique in detail along with the surgical procedure, postoperative rehabilitation and the possible complications.

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How to Cite this article: Goyal & Modi. Gel Based Autologous Chondrocyte Implantation: The Surgical Technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):27-33 .

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Scaffold based Autologous Chondrocyte Implantation: The Surgical Technique

Professor Mats Brittberg

Volume 4 | Issue 1 | Jan – April 2019 | Page 23- 26

Author: Professor Mats Brittberg[1]

[1] Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, S-434 80 Kungsbacka Sweden.

Address of Correspondence
Professor- Mats Brittberg
Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, S-434 80 Kungsbacka Sweden.
Email: Mats.brittberg@telia.com

Abstract

Autologous chondrocyte implantation (ACI) has been used clinically since 1987. Most reports on ACI are on the first and second generation ACI with cells in suspension under a sutured membrane and performed with open surgery. Today’s 3rd and 4th generation ACI with cells seeded and grown in or on scaffolds prior to implantation opens up for transarthroscopic implantations. Transarthroscopic surgery reduces the morbidity for the patients and also fastens up the rehab process. In this paper, techniques used for scaffold-based ACI are presented.

References

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10.Vascellari A, Rebuzzi E, Schiavetti et al. Implantation of matrix-induced autologous chondrocyte (MACI(®)) grafts using carbon dioxide insufflation arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2014 Jan;22(1):219-25.
11.Marcacci M, Berruto M, Brocchetta D et al. Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res.2005; Jun;(435):96-105
12.Della Villa S, Kon E, Filardo G et al. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? Am J Sports Med. 2010; Jan;38(1):68-77.

How to Cite this article: Brittberg M. Scaffold based autologous chondrocyte implantation: The surgical technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):23-26 .

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The Mosaicplasty / OAT procedure: Technique, Pearls and Pitfalls

Rajkumar Amaravathi, Renato Andrade, Ricardo Bastos, João Espregueira-Mendes

Volume 4 | Issue 1 | Jan – April 2019 | Page 15-22

Author: Rajkumar Amaravathi [1], Renato Andrade [2,3,4], Ricardo Bastos [2,3,5,6], João Espregueira-Mendes [2]

[1] Department Of Orthopedics, Division of Arthroscopy and Sports Surgery, St. John’s Medical College and Hospital, Bangalore 560034,India
[2] Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal.
[3] Dom Henrique Research Centre, Porto, Portugal.
[4] Faculty of Sports, University of Porto, Porto, Portugal.
[5] Fluminense Federal University, Niteroi, Brazil.
[6] ICVS/3B’s-PT Government Associate Laboratory, Guimarães, Portugal.
[7] School of Medicine, Minho University, Braga, Portugal.

Address of Correspondence
Dr João Espregueira-Mendes,
M.D., Ph.D.; Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence,
Estádio do Dragão, Entrada Nascente, Piso -3, 4350-415, Porto, Portugal.
Email: espregueira@dhresearchcentre.com

Abstract

Osteochondral autologous transplantation is a surgical procedure that involves the transplant of the autologous cartilage from the non-weight bearing areas of the knee to the articular defect. It has the advantage of being a single stage procedure, repairs the subchondral bone, provides hyaline cartilage and allows a fast return to play. It is indicated for small and medium-sized defects, but the mosaicplasty technique allows treating defects up to 9 cm2. A major disadvantage of this technique is the donor site morbidity associated with the graft harvesting. To overcome this drawback, we harvest the autografts from the upper tibio-fibular joint with low or none donor site morbidity. Osteochondral autologous transplantation and mosaicplasty procedures remain an excellent option for small to medium osteochondral injuries resulting in long-term good to excellent clinical and imaging outcomes.Osteochondral autologous transplantation is a surgical procedure that involves the transplant of the autologous cartilage from the non-weight bearing areas of the knee to the articular defect. It has the advantage of being a single stage procedure, repairs the subchondral bone, provides hyaline cartilage and allows a fast return to play. It is indicated for small and medium-sized defects, but the mosaicplasty technique allows treating defects up to 9 cm2. A major disadvantage of this technique is the donor site morbidity associated with graft harvesting. To overcome this drawback, we harvest the autografts from the upper tibio-fibular joint with low or none donor site morbidity. Osteochondral autologous transplantation and mosaicplasty procedures remain an excellent option for small to medium osteochondral injuries resulting in long-term good to excellent clinical and imaging outcomes.

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How to Cite this article: Rajkumar Amaravathi R, Andrade R, Bastos R, Espregueira-Mendes J. The Mosaicplasty / OAT procedure: Technique, Pearls and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1):15-22 .

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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis

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Imaging for Cartilage injuries

Anupama Patil, Aniket Jadhav

Volume 4 | Issue 1 | Jan – April 2019 | Page 4-8

Author: Anupama Patil[1], Aniket Jadhav[1]

STAR imaging and research centre, Joshi Hospital Campus Opposite Kamla Nehru Park, Erandwane, Pune, Maharashtra.

Address of Correspondence
Dr Anupama Patil
STAR imaging and research centre, Joshi Hospital Campus Opposite Kamla Nehru Park, Erandwane, Pune, Maharashtra 411004
Email: anupama.patil2003@gmail.com

Abstract

Chondral injuries can occur in an isolated manner or, more commonly, in association with osseous or soft tissue injuries. Accurate pre-knowledge of the chondral injury and associated injuries help the orthopedic surgeon in planning appropriate treatment procedures. Advances in various treatment techniques for chondral defects places paramount importance on the identification, and quantification of these injuries. Through this article, we present a review of literature regarding Magnetic resonance imaging assessment of chondral injuries, also addressing the scan parameters used, advances in imaging for cartilage, role of Magnetic resonance imaging in postoperative follow-up, comparison of accuracy of Magnetic resonance imaging with arthroscopy as well as the roles of ultrasonography and computed tomography in evaluation of articular cartilage.
Magnetic resonance imaging has an indispensable role in the pre-arthroscopic work-up and post-arthroscopic follow-up of chondral injuries. It gives an accurate knowledge of chondral defects/ injuries, staging of lesions, evaluating subchondral bone, assessing adjacent cartilage, identifying loose bodies in remote recesses likely to be missed on arthroscopy, and identifying another ligament/meniscal tears. It is also useful in assessing the donor and recipient sites in
The post-arthroscopic workup following cartilage repair. Ultrasound arthroscopy is a new quantitative intra-operative imaging modality, still not widely used. Computed tomography doesn’t image the cartilage directly but plays an important ancillary role in the evaluation of subchondral bone and identification of location and size of loose bodies.

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How to Cite this article: Patil A, Jadhav A. Imaging for Cartilage injuries. Asian Journal Arthroscopy. Jan-April 2019;4(1):4-8 .

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Endoscopic Plantar Fasciotomy with Gastrocnemius Recession for Chronic Plantar Fasciitis

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A Surgical Perspective to the Modern Cartilage Repair Techniques

Dr. Deepak Goyal

Volume 4 | Issue 1 | Jan – April 2019 | Page 2-3

Author: Deepak Goyal [1]

Consultant Cartilage and Sports Knee Surgeon, Saumya Arthroscopy & Sports Knee Clinic, Ahmedabad, India.

Address of Correspondence
Dr. Deepak Goyal,
Consultant Cartilage and Sports Knee Surgeon
Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.
Email: deepak@knee.in

Abstract

Hunter [1] in AD 1742 had observed, ‘Cartilage once damaged cannot heal’ and the orthopedic community continued to believe in his statement for over 200 years. There were some scattered attempts and observations to heal the cartilage in the later-half of the twentieth century. We have seen an enthusiastic interest with many new modalities showing varying degrees of cartilage repair success in the last 25 years. While traveling across Asian countries, I come across many surgeons who have an active interest in the cartilage repair. Young enthusiast surgeons are keen to learn techniques and develop skills for various cartilage repair procedures. But, many of them are unable to do more than the microfracture technique, the first line of treatment [2]. Asian Journal of Arthroscopy, is keen to infuse the basic know-how of commonly done procedures along with a stress on practical approach towards the procedures. Literature is abundant about each of the cartilage repair procedures, but a ‘beginner cartilage surgeon’ would like to know the basics of case selection, decision making, surgical techniques, and tips, along with the possible complications. This special issue on cartilage repair invited different surgeons/ doctors who are doing pioneer work in their respective fields of cartilage repair.

Patil and Jadhav [3] have started this edition of AJA with a detailed understanding of various sequences of MRI that are important for the diagnosis of the cartilage lesions. They have not only described the various zones of cartilage on MRI but have also discussed in detail about the T2 mapping. The various MRI characteristics of damaged cartilage and repaired cartilage are also discussed along with the MOCART score.

Devin Leland et at [4] have written a nice article on the microfracture technique that is specifically indicated for the small size lesions. They have given a detailed discussion on the indications, surgical steps, and the site-specific rehabilitation program; while using the microfracture technique. They have also discussed short and long-term results of the microfracture technique along with a brief discussion on various systematic reviews. To conclude, they have also compared the results of the subchondral drilling technique and the osteochondral grafting.

Amaravathi et al [5] advocate osteochondral cylinder transfer technique for mid-size cartilage lesions. They have put a special emphasis on the proper case selection, pre-operative planning, and the surgical technique, along with the detailed tabulated pearls and pitfalls for each. The discussion about long-term results (15 years) of the osteochondral cylinder transfer procedures by various authors is quite promising in favor of the technique. Their suggestion on the use of the proximal tibiofibular joint as the source of the graft will be interesting to watch, with the long-term results in the future.

Mats Brittberg [6] has written a very nice article on 3rd generation ACI and has tried to remove the confusion between the nomenclature of various methods that fall under the ambit of 3rd generation ACI. He has also introduced the 4th generation ACI with this article that will allow the surgeons to use ACI as a single stage surgery.

Goyal and Modi [7] have advocated the use of the gel based ACI procedure, another 3rd generation ACI, mainly for the large chondral lesions with a cautious use in the extra-large lesions. They have heavily emphasised on a very careful selection of the patient using stringent guidelines and a preoperative planning methodology. A detailed step-by-step surgical technique discussion and a postoperative rehabilitation program is also discussed, along with an insight into the possible complications.

Herman et al [8] have stressed the importance of a single stage technique of cartilage repair using hyaluronic acid-based scaffold with the bone marrow aspirate concentrate. They have described the surgical technique along with a detailed understanding of the various phases of the rehabilitation program.

I hope, many youngsters as well as seniors will find this special issue on cartilage repair, useful.

References

1. Hunter W. Of the structure and diseases of articulating cartilages, by William Hunter, surgeon. Philos Trans R Soc Lond 1742;42:514-521.
2. Goyal D, Keyhani S, Lee EH, Hui JHP. Evidence-Based Status of Microfracture Technique: A Systematic Review of Level I and II Studies. Arthroscopy. 2013;29(9):1579-1588.
3. Patil A, Jadhav A. Imaging for Cartilage injuries. Asian Journal Arthroscopy. Jan-April 2019;4(1): 4-8.
4. Leland DP, Bernard CD, Krych AJ. The Microfracture Technique: Pearls and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1):9-14
5. Amaravathi R, Andrade R, Bastos R, Espregueira-Mendes J. The Mosaicplasty/ OAT procedure: Technique, Pearls, and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1): 15-22.
6. Brittberg M. Scaffold-based autologous chondrocyte implantation: The surgical technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):23-26
7. Goyal & Modi. Gel-Based Autologous Chondrocyte Implantation: The Surgical Technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):27-33.
8. Herman K, Kumar V, Szwedowski D, Chierici L, Gobbi A. HA-BMAC: The Surgical Technique, Pearls and Pitfalls. Asian Journal Arthroscopy. Jan-April 2019;4(1):34-37

How to Cite this article: Goyal D. A Surgical Perspective to the Modern Cartilage Repair Techniques. Asian Journal of Arthroscopy Jan – April 2019;4(1):2-3

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