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ObjectiveThis study aimed to investigate the relationship between clinical findings and the trabecular microstructure of the subchondral bone in patients with hip osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) using multidetector row computed tomography (MDCT).DesignA total of 63 patients (69 hips) with OA due to DDH were retrospectively reviewed, with 12 healthy controls being included for comparison. Clinical evaluation was performed using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). The trabecular bone microstructure was analyzed using MDCT. Regions of interest in the subchondral trabecular bones of the acetabulum and femoral head were defined in the coronal view, and various trabecular microstructural parameters were evaluated.ResultsBone volume fraction (BV/TV) and trabecular thickness (Tb.Th) exhibited a significant positive correlation with the OA stage, whereas trabecular separation (Tb.Sp) showed a negative correlation. In addition, BV/TV and Tb.Th were negatively correlated with the JHEQ total and pain scores, whereas Tb.Sp was positively correlated with the pain score in all regions.ConclusionsThis is the first study to evaluate the bone microstructure and its relationship with clinical findings in patients with hip OA due to DDH. Our findings suggest that as OA progresses, osteosclerotic changes increase in the acetabulum and femoral head; these changes are associated with worsening clinical symptoms, particularly pain. Targeting the subchondral bone may emerge as a novel treatment strategy for patients with OA due to DDH; nevertheless, further comprehensive studies are required.

ObjectiveTraditional autologous chondrocyte implantation (ACI) involves arthroscopically harvesting a cartilage biopsy (stage 1), followed by arthrotomy 3 to 4 weeks later to apply a periosteal patch and implant culture-expanded chondrocytes underneath (stage 2). This study aimed to determine if patch application during stage 1 rather than stage 2 improved clinical outcome.DesignA randomized controlled trial was conducted from 1998 to 2001. Patients were randomized to receive either traditional ACI (control/late) or ACI with "early" patch during stage 1 (intervention/early). Clinical outcome (Lysholm score) was assessed pre-operatively and annually post-operatively.ResultsSeventy-seven patients were recruited, with 40 patients randomized to the early and 37 to the late patch group. The overall mean pre-operative Lysholm score was 51.8 (range 11-89) and significantly improved by 11.1 points (95% confidence interval [CI] = 4.8 to 17.4) at mean 12.7 years (range 1.5-23.7) follow-up. Latest mean Lysholm scores for the early and late groups were 68.4 (95% CI = 19 to 100) versus 56.7 (95% CI = 18 to 98). Adjusted for covariate imbalances, no evidence was found for a difference between the groups (mean difference = 8.5, 95% CI = -5.2 to 22.2, P = 0.22). Twenty-year survival until any re-operation or arthroplasty was 59.6%/82.1% for the early and 56.8%/69.5% for the late group, with no evidence for a difference.ConclusionACI is an effective durable treatment for cartilage defects, with high levels of patient satisfaction and low failure rates. No evidence was found that applying the periosteal patch at the time of chondrocyte harvest improved long-term Lysholm scores or survival until any re-operation or arthroplasty.

ObjectiveA gold standard surgical treatment for osteochondral lesions (OCLs) of the talus still needs to be established. Still, autologous matrix-induced chondrogenesis (AMIC) is a commonly applied 1-stage procedure that has achieved good short- and mid-term results. The present cohort study aimed to assess whether the long-term, 10-year results can confirm the previous findings.DesignAll patients underwent an open AMIC procedure using a collagen type I/III bilayer matrix for a talar OCL. General demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1, 5, and 10 years as well as European Foot and Ankle Society (EFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores at 10 years after surgery were analyzed. The primary outcome variable was the procedure's longitudinal effect, and several variables' influence on the outcome was tested.ResultsOf 47 consecutive patients, 18 (38%) were included. Of the 18 patients, 6 (33%) were female, and 12 (67%) were male, with a mean age of 39 ± 15 (range = 15-62) and an average body mass index (BMI) of 26 ± 5 (range = 20-38) kg/m². The mean defect size was 1.4 ± 0.9 (range = 0.2-4) cm². The FFI-D total score showed a significant decrease from preoperatively to 1 year postoperatively (56 ± 19 to 34 ± 27; P = 0.001) with a further nonsignificant decrease to the 5-year (34 ± 27 to 21 ± 20; P = 0.16) and 10-year follow-up (21 ± 20 to 15 ± 13; P = 1.00). All the single items decreased significantly from preoperatively to the 5- and 10-year mark. Although not significant, most items improved from 5 to 10 years postoperatively. Age positively correlated with the preoperative, 5-year, and 10-year follow-up FFI-D total score.ConclusionsAMIC, as a single-step surgical intervention, is a viable long-term treatment option. Patient selection regarding symptoms and findings is vital to achieve satisfying results.

ObjectivesViscosupplementation with hyaluronic acid (HA) is a commonly used intra-articular treatment for osteoarthritis (OA). We performed a Delphi consensus process to formulate guidelines for the use of intra-articular hyaluronic acid (IAHA) knee injection according to the patient's characteristics.MethodsThe EUROVISCO group consists of 12 members who had expertise in clinical and/or research in the field of OA and IAHA treatment. This group drafted issues through an iterative process and subsequently voted according to a Delphi process on their level of agreement (LoA) on these recommendations. The scores were pooled to generate a median agreement score for each recommendation. The strength of the recommendation (SOR) was classified as strong if the median agreement score was ≥8. The level of consensus (LOC) was also obtained. The level of evidence was given for each recommendation.Results:A total of 34 statements were evaluated by the expert group. A unanimous or high LoA was obtained in 16. IAHA can be considered irrespective of the age in patients with symptomatic knee OA. It can be used in patients with diabetes and/or moderate to severe obesity. It can also be used in knee OA patients with a history of gout, meniscocalcinosis and with mild-to-moderate varus/valgus malalignment. The group recommended against the use of VS in pregnant women and in OA flare.ConclusionIn summary, the working group provided strong recommendations for the use of IAHA injection that will facilitate individualized treatment decision algorithms in the management of knee OA.

ObjectiveCytokines are implicated in the pathogenesis of osteoarthritis (OA), and this study aims to assess the therapeutic potential of an IL-8 neutralizing monoclonal antibody (mAb) for OA intervention.DesignThe study employed a rabbit model of OA induced by anterior cruciate ligament transection (ACLT) surgery to investigate the effects of an interleukin (IL)-8 neutralizing mAb, with hyaluronic acid (HA) used as a positive control. Primary outcomes assessed in the rabbits included cartilage repair, synovitis, joint effusion, changes in footprints, and lower limb loading conditions.ResultsCompared to HA, intra-articular injection of the IL-8 neutralizing mAb demonstrated a more pronounced attenuation of OA progression and enhancement of cartilage repair. We observed a reduction in synovitis and joint effusion, indications of bone marrow edema, as well as improvements in lower limb function. In knees treated with the neutralizing IL-8 mAb, there was a significant decrease in IL-8 levels within the synovial tissues.ConclusionsThe IL-8 neutralizing mAb exhibits promising therapeutic potential in the management of OA by attenuating inflammation and facilitating cartilage repair. However, further investigations are warranted to comprehensively elucidate the underlying mechanisms, optimize treatment protocols, and ensure the long-term safety and efficacy of this innovative therapeutic approach.

ObjectiveTo synthesize the literature concerning return to sport (RTS) and related outcomes after cartilage restoration surgery of the knee in professional athletes.DesignCochrane, PubMed, and OVID/Medline databases were queried for data pertaining to RTS after knee cartilage surgery in professional athletes. Demographic information, cartilage lesion characteristics, and RTS-specific information were extracted. Freeman-Tukey Double-Arscine Transformations with Dersimonian-Laerd random-effects estimators were constructed to quantitatively describe the cumulative incidence of RTS, while heterogeneous data described narratively.ResultsEleven studies (476 athletes; mean age 27.5 ± 2.1 years; 96.6% male) were included. Nine (81.8%) studies investigated a form of microfracture as treatment, with 6 (54.5%) performing isolated microfracture. The remaining studies investigated osteochondral allograft transplantation and mosaicplasty. More than half (n = 6; 54.5%) did not report cartilage lesion location or size. The pooled RTS rate was 84.3% (95% CI: 75.4%-91.8%) at a mean 39.9 (range, 12-104) weeks postoperatively. In 6 studies reporting competition level, a trend toward returning to a lower than pre-injury level was observed. The definition of RTS was only provided in 6 (54.5%) studies, while the criteria for RTS was only reported in 2 (18.2%) studies, suggesting limited transparency. One study reported an objective imaging assessment of reparative tissue, while none reported formal RTS testing protocols or minimum RTS timeline.ConclusionAlthough the majority of professional athletes are reported to achieve a successful RTS after cartilage restoration surgery of the knee, the literature predominantly reflects microfracture treatment. Current limitations in this literature include a substantial lack of female representation and infrequent reporting of cartilage lesion characteristics, rehabilitation and RTS criteria, and objective imaging assessments of reparative tissue.

ObjectiveThis study aimed to evaluate clinical outcomes and cartilage repair following autologous chondrocyte implantation (ACI) combined with high tibial osteotomy (HTO) in elderly patients with spontaneous osteonecrosis of the knee (SONK) presenting with large cartilage defects.DesignEleven knees of 11 patients with SONK (lesion size ≥4 cm²) aged 60 years or older underwent ACI and concomitant opening-wedge HTO. Patients were followed for at least 1 year. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was evaluated arthroscopically using the International Cartilage Repair Society (ICRS) grade and histologically using the ICRS II score at second-look arthroscopy.ResultsThe overall KOOS improved significantly from a preoperative value of 38.4 ± 8.5 to a 1-year postoperative value of 77.8 ± 10.9 (P < 0.01). Arthroscopy showed cartilage repair to normal or nearly normal in 91% of cases. The mean histological ICRS II score was 67.5 ± 16.2. No postoperative complications or need for additional surgical interventions was observed.ConclusionsACI combined with HTO provides good clinical and histological outcomes in elderly patients with SONK and large cartilage defects. This approach represents an effective joint-preserving treatment option, even in patients aged 60 years or older.

PurposeTo clarify and standardize sagittal tibial tubercle-trochlear groove (sTTTG) numerical values in the literature.ResultsSagittal tibial tubercle-trochlear groove distance has been recently popularized as a quantitative marker of patellofemoral contact forces and correlated to patellofemoral chondral lesion incidence, size, and osteoarthritis. There remains controversy over the precise definition of sTTTG.ConclusionThe current erratum clarifies that a relatively anterior tibial tubercle compared to the trochlear groove is quantified as a positive sTTTG, whereas a relatively posterior tibial tubercle compared to the trochlear groove is quantified as a negative sTTTG.

BackgroundKnee bursae are potential sources of anterior, medial, lateral, and posterior knee pain, yet many remain under-recognized in clinical practice. Emerging biological therapies offer promising, minimally invasive options for resistant bursitis, but high-level evidence is limited for several bursal types.PurposeTo systematically review the anatomy, clinical presentation, imaging characteristics, treatment strategies, and outcomes of 11 distinct knee bursae, with emphasis on the role of biologic therapies.MethodsThis systematic review followed PRISMA guidelines. PubMed and Embase were searched (2000-2024) for studies addressing anatomy, diagnosis, imaging, treatment (conservative, injection-based, biologic, or surgical), and outcomes of knee bursae. Studies involving human subjects, published in English, and reporting clinical, imaging, or therapeutic data were included. Levels of Evidence (LOE) were assigned using Oxford criteria.ResultsA total of 76 studies were included. Several randomized controlled trials (LOE I) focused on pes anserine and OA-related bursitis, while additional Level II studies assessed PRP and corticosteroids. Data on rare bursae (e.g., LCL, deep infrapatellar) were primarily derived from imaging reviews and case series (LOE III-IV). Corticosteroid injections showed recurrence rates of 20% to 40%. PRP and PRP+HA demonstrated improved pain relief and reduced recurrence in selected bursae, although protocols remain heterogeneous.ConclusionConservative management remains first-line for most bursae. PRP-based therapies, especially in pes anserine and OA-related bursitis, offer promising alternatives in refractory cases. Although several Level I-II studies support their efficacy, additional high-quality RCTs are warranted-particularly for understudied bursae.