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PubMed2005

[Treatment of talar chondral lesions by solid chondral graft -- first experience].

The aim of this report is to draw attention to new possibilities of treating chondral lesions of the talus, using a solid chondral graft consisting of autologous chondrocytes grown on a three-dimensional matrix of the tissue glue Tissucol. This method is used in grade II to grade IV chronic lesions and grade IV acute lesions, as classified according to the Berndt and Harty system. Patients' age at implantation should not exceed 40 years. When a lesion is found by arthroscopy on the talar dome, a part of cartilage from a non-weight-bearing surface, most frequently the neck of the talus or the anterior edge of the tibia, is collected. The cartilage is sent to the tissue bank. The preparation of a chondral graft (fragmentation, isolation and cultivation of chondrocytes) takes from 15 to 35 days. After shaping the graft from chondrocytes and Tissucol tissue glue in a special mould, transplantation is carried out. In 2003 we used this method in two patients. They both were male sportsmen, football players, aged 35 and 30 years, respectively. At the time of this report, the former patient was 8 months and the latter 3 months after implantation. The first patient, aged 35, was without complaints at 8 months after implantation. The other patient, a 30-year-old football player, who was still followed up, was without complaints and continued with rehabilitation and full weight-bearing of the extremity. Magnetic resonance imaging performed 3 months post-operatively showed good incorporation of the chondral graft in both patients.

Adult↗

PubMed2005

[Heel pain].

Heel pain is quite frequent clinical symptom in our population. Successful therapy derives from the problem aetiology. The most frequent source of pain is the mechanical basis, both on dorsal and plantar side of calcaneum. Therapy includes a variety of procedures, from routine measures to surgical intervention.

Biomechanical Phenomena↗

PubMed2004

[Treatment of patellar cartilage defects by solid chondral graft: first experience].

PURPOSE OF THE STUDY: To present the results of a new method for treatment of cartilage defects of the patella, using a solid graft produced by chondrocytes on a three-dimensional matrix. MATERIAL AND METHODS: Chondrocyte transplantation is indicated in deep and extensive chondral and osteochondral defects of all large joints in patients at 18 to 40 years of age. When, on arthroscopic examination, a defect of patellar cartilage was found, healthy cartilage was collected from a non-weight-bearing surface, i. e., the intercondyllar fossa. In the tissue bank, the cartilage was fragmented, chondrocytes were isolated enzymatically and cultivated in vitro under a permanent assessment for cell quality. The cultivation period ranged from 15 to 35 days. Subsequently, a solid graft was prepared with the use of Tissucol glue, a three-dimensional matrix. The graft was transplanted after arthroscopic verification of the defect by an open, minimally invasive procedure with tourniquet application, with the patient receiving antibiotics. The result of chondral graft implantation was checked by second-look arthroscopy involving removal of a small sample of the integrated chondral graft taken for histological and morphological examination. Another method of post-operative assessment was examination by magnetic resonance imaging (MRI). Solid chondral graft transplantation was used in three patients (two men and one women) treated in the Department of Orthopedics, University Hospital Brno, between May 2001 and December 2003. Their average age at the time of surgery was 31 years (range, 27 to 38 years). The average follow-up was 22 months (range, 2 to 33 months). The post-operative stage of he cartilage was assessed by MRI in one patient and by second-look arthroscopy also in one patient. RESULTS: Two patients fully resumed their daily activities, sports including, at 6 months after the treatment, with one reporting mild chondropathic problems and the other being without complaints. In the third patient at 2 months after surgery, the treatment had not been completed yet. The patella examined by MRI at 18 months after surgery showed a confluent, high layer of hyaline cartilage covering the articular surface. Second-look arthroscopy and histological examination also revealed healthy hyaline cartilage. No serious complications were recorded. DISCUSSION: Autologous chondrocyte transplantation is indicated in younger, active patients with cartilage defects exceeding 2 cm2 and in patients undergoing revision surgery for any defect. The success rate of this procedure has been reported to be over 90 %. One year after transplantation, the cartilage had characteristics of a healthy tissue, as assessed by MRI. Biopsy examination showed that the grafts, chondrocytes as well as osteocytes maintained their integrity at 2 to 12 months after surgery. CONCLUSIONS: The aim of this paper was to define and check indications, to develop the surgical technique, to improve post-operative management and to evaluate mid-term results of the treatment of cartilage defects on the patella.

Adolescent↗