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[PMID]:28577709
[Au] Autor:Albright JC; Daoud AK
[Ad] Endereço:Department of Orthopedics, Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045, USA. Electronic address: jay.albright@childrenscolorado.org.
[Ti] Título:Microfracture and Microfracture Plus.
[So] Source:Clin Sports Med;36(3):501-507, 2017 Jul.
[Is] ISSN:1556-228X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Articular cartilage damage remains a significant cause for early osteoarthritis in adolescents and young adults. After chondroplasty alone, the mainstay procedure for cartilage injuries is microfracture. Although in small lesions this may be successful long-term, positive results of treating larger lesions this way are less certain. This inconsistency in outcomes has led to augmentation of these defects with scaffolding for autograft regeneration or for allograft cartilage to fill the defect with a hyaline cartilage. This discussion includes current techniques for the addition of scaffolding to the microfracture defect for larger lesions, the rationale, and preliminary results.
[Mh] Termos MeSH primário: Artroplastia Subcondral/métodos
Doenças das Cartilagens/cirurgia
Cartilagem Articular/cirurgia
[Mh] Termos MeSH secundário: Transplante Ósseo/métodos
Cartilagem/transplante
Cartilagem Articular/lesões
Seres Humanos
Tecidos Suporte
Transplante Autólogo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170605
[St] Status:MEDLINE


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[PMID]:28328166
[Au] Autor:Roquet I; Lane Easter J; Coomer RPC; Ezquerra LJ; Marsh CA; Trostle SS; Santschi EM
[Ad] Endereço:Department of Equine Surgery, Universidad de Extremadura, Caceres, Spain.
[Ti] Título:Treatment of subchondral lucencies in the medial proximal radius with a bone screw in 8 horses.
[So] Source:Vet Surg;46(4):478-485, 2017 May.
[Is] ISSN:1532-950X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe the results of screw placement through subchondral lucencies (SCL) of the proximal radius in 8 horses. STUDY DESIGN: Retrospective clinical study. ANIMALS: Horses with cubital SCL causing lameness (n=8). METHODS: Medical record review and clinical follow-up. RESULTS: Eight horses with SCL in the proximal radius causing lameness were treated with a screw placed across the lucency. The horses range in age from 1 to 20 years. In 4 of 8 horses, the lameness had been intermittently severe (apparent at the walk). Lameness was isolated to the cubital joint by intra-articular anesthesia in 5 horses and diagnosed radiographically in all 8. All horses had a 4.5 mm cortical bone screw placed from medial to lateral (6 lag, 2 neutral) across the SCL using fluoroscopic or radiographic control. Postoperative care included stall confinement with hand walking for 30-60 days, followed by an additional 30-60 days of pasture turnout. Radiographic SCL healing (reduction in SCL size) was demonstrated at 3-4 months after surgery in all horses, and 7/8 horses (87.5%) were used as intended (4 performance, 3 pasture turn-out) within 6 months. Lameness in the remaining horse improved initially (dressage) but returned. CONCLUSIONS: A screw placed through the SCL of the proximal-medial radius was effective in reducing or resolving lameness associated with the elbow joint in 7/8 horses (88%). Screw placement in the proximal radius should be considered for horses with lameness caused by an SCL when a quick return to exercise is desired or conservative therapy is ineffective.
[Mh] Termos MeSH primário: Artroplastia Subcondral/veterinária
Doenças Ósseas Metabólicas/veterinária
Parafusos Ósseos/veterinária
Doenças dos Cavalos/cirurgia
[Mh] Termos MeSH secundário: Animais
Artroplastia Subcondral/métodos
Doenças Ósseas Metabólicas/cirurgia
Feminino
Cavalos
Coxeadura Animal/etiologia
Masculino
Rádio (Anatomia)
Estudos Retrospectivos
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE
[do] DOI:10.1111/vsu.12643


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[PMID]:28320425
[Au] Autor:Polat G; Karademir G; Akalan E; Asik M; Erdil M
[Ad] Endereço:Department of Orthopaedics and Traumatology, Istanbul University, Istanbul Medical Faculty, Çapa-Fatih, Istanbul, 34093, Turkey. gokhanpolat7@gmail.com.
[Ti] Título:Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions.
[So] Source:J Orthop Surg Res;12(1):46, 2017 Mar 20.
[Is] ISSN:1749-799X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL). METHODS: Fourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week. RESULTS: The mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8 (one non-compliant patient). The mean value was 4.34% ±0.8 at the first postoperative week (two non-compliant patients), 6.95% ±2.3 at the third postoperative week (eight non-compliant patients), and 10.8% ±4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall's tau b = -0.445 and p = 0.0228). CONCLUSIONS: Although patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week.
[Mh] Termos MeSH primário: Artroplastia Subcondral/reabilitação
Osteocondrose/cirurgia
Cooperação do Paciente
Tálus/cirurgia
Suporte de Carga/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Artroplastia Subcondral/métodos
Artroscopia/métodos
Desbridamento/métodos
Feminino
Marcha
Seres Humanos
Masculino
Osteocondrose/reabilitação
Medição da Dor
Dor Pós-Operatória
Cuidados Pós-Operatórios/métodos
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170522
[Lr] Data última revisão:
170522
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1186/s13018-017-0548-5


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[PMID]:28045867
[Au] Autor:Frank RM; Cotter EJ; Nassar I; Cole B
[Ad] Endereço:*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL †El-Hadara University Hospital, Alexandria University, Alexandria, Egypt.
[Ti] Título:Failure of Bone Marrow Stimulation Techniques.
[So] Source:Sports Med Arthrosc;25(1):2-9, 2017 Mar.
[Is] ISSN:1538-1951
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Marrow stimulation techniques, including microfracture, are among the most commonly performed cartilage restoration procedures for symptomatic chondral defects of the knee. For the vast majority of patients, marrow stimulation results in reduced pain and improved function, providing overall satisfactory outcomes. In some cases, however, marrow stimulation fails, resulting in symptom recurrence and often, the need for repeat surgery. This review will describe the indications and outcomes of microfracture as a primary surgical treatment for focal chondral defects of the knee, identify patient and procedure-specific factors associated with poor clinical outcomes, and will discuss treatment options and their respective outcomes for patients with a failed prior microfracture surgery.
[Mh] Termos MeSH primário: Artroplastia Subcondral/métodos
Cartilagem Articular/lesões
Transtornos Traumáticos Cumulativos/cirurgia
Traumatismos do Joelho/cirurgia
Reoperação/métodos
[Mh] Termos MeSH secundário: Seres Humanos
Falha de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170104
[St] Status:MEDLINE
[do] DOI:10.1097/JSA.0000000000000134


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[PMID]:27661195
[Au] Autor:Mosier BA; Arendt EA; Dahm DL; Dejour D; Gomoll AH
[Ad] Endereço:From Brigham and Women' Hospital, Boston, MA (Dr. Mosier and Dr. Gomoll), the University of Minnesota Twin Cities, Minneapolis, MN (Dr. Arendt), Mayo Clinic, Rochester, MN (Dr. Dahm), and the Lyon-Ortho-Clinic, Lyon, France (Dr. Dejour).
[Ti] Título:Management of Patellofemoral Arthritis: From Cartilage Restoration to Arthroplasty.
[So] Source:J Am Acad Orthop Surg;24(11):e163-e173, 2016 Nov.
[Is] ISSN:1940-5480
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The management of patellofemoral cartilage lesions is controversial and should begin with a comprehensive nonsurgical treatment plan. Patients with patellofemoral cartilage lesions in whom nonsurgical treatment fails may be candidates for surgical treatment. Surgical treatment strategies for the management of patellofemoral cartilage lesions are guided by the size, quality, and location of the defect. Recent advancements in cartilage restoration and arthroplasty techniques as well as appropriate patient selection and meticulous surgical technique have resulted in promising outcomes in patients with patellofemoral cartilage lesions who undergo surgical treatment.
[Mh] Termos MeSH primário: Cartilagem Articular/cirurgia
Osteoartrite do Joelho/diagnóstico
Osteoartrite do Joelho/cirurgia
Articulação Patelofemoral/cirurgia
[Mh] Termos MeSH secundário: Artroplastia do Joelho
Artroplastia Subcondral
Transplante Ósseo
Cartilagem/transplante
Condrócitos/transplante
Desbridamento
Seres Humanos
Anamnese
Osteoartrite do Joelho/terapia
Seleção de Pacientes
Exame Físico
Modalidades de Fisioterapia
Radiografia
Transplante Autólogo
Transplante Homólogo
[Pt] Tipo de publicação:JOURNAL ARTICLE; LECTURES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160924
[St] Status:MEDLINE


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[PMID]:27623504
[Au] Autor:Agten CA; Kaplan DJ; Jazrawi LM; Burke CJ
[Ad] Endereço:1 Center for Musculoskeletal Care, NYU Langone Medical Center, New York, NY.
[Ti] Título:Subchondroplasty: What the Radiologist Needs to Know.
[So] Source:AJR Am J Roentgenol;207(6):1257-1262, 2016 Dec.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Subchondroplasty is a novel minimally invasive procedure that is used to treat painful bone marrow lesions in patients with knee osteoarthritis or insufficiency fractures. The objective of this article is to describe the surgical technique and the pre- and postoperative imaging findings of a small case series acquired at a single center. CONCLUSION: The radiologist should be familiar with the anticipated postoperative imaging appearances after subchondroplasty and the potential complications.
[Mh] Termos MeSH primário: Artroplastia Subcondral/métodos
Doenças da Medula Óssea/diagnóstico por imagem
Doenças da Medula Óssea/cirurgia
Edema/diagnóstico por imagem
Edema/cirurgia
Imagem por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Artroplastia Subcondral/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Cirurgia Assistida por Computador/efeitos adversos
Cirurgia Assistida por Computador/métodos
Tomografia Computadorizada por Raios X/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160914
[St] Status:MEDLINE


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[PMID]:27535450
[Au] Autor:Fu FH; Soni A
[Ad] Endereço:University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
[Ti] Título:ACI Versus Microfracture: The Debate Continues: Commentary on an article by Gunnar Knutsen, MD, PhD, et al.: "A Randomized Multicenter Trial Comparing Autologous Chrondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years".
[So] Source:J Bone Joint Surg Am;98(16):e69, 2016 08 17.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Artroplastia Subcondral
Fraturas de Estresse
[Mh] Termos MeSH secundário: Cartilagem Articular/cirurgia
Condrócitos
Seguimentos
Seres Humanos
Transplante Autólogo
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160819
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.00565


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[PMID]:27513796
[Au] Autor:Smith G; Frank T; Guy P
[Ad] Endereço:Norfolk and Norwich University Hospitals , Norwich , UK.
[Ti] Título:Subchondral bone purchase can aid femoral head extraction.
[So] Source:Ann R Coll Surg Engl;98(8):591, 2016 Nov.
[Is] ISSN:1478-7083
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Fraturas do Fêmur/cirurgia
Cabeça do Fêmur/cirurgia
[Mh] Termos MeSH secundário: Artroplastia Subcondral/métodos
Seres Humanos
Instrumentos Cirúrgicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160812
[St] Status:MEDLINE


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[PMID]:27487736
[Au] Autor:Pareek A; Reardon PJ; Macalena JA; Levy BA; Stuart MJ; Williams RJ; Krych AJ
[Ad] Endereço:Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
[Ti] Título:Osteochondral Autograft Transfer Versus Microfracture in the Knee: A Meta-analysis of Prospective Comparative Studies at Midterm.
[So] Source:Arthroscopy;32(10):2118-2130, 2016 Oct.
[Is] ISSN:1526-3231
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To compare microfracture (MFX) and osteochondral autograft transfer (OAT) surgical techniques to determine (1) postoperative activity level, (2) subjective patient outcomes, (3) failure rates, and (4) assess if any lesion characteristics favored one technique over the other. METHODS: A comprehensive review of literature was performed of all studies comparing MFX and OAT. Studies included were all prospective studies that reported on activity-based outcome measures such as Tegner activity scores and subjective outcomes such as the International Knee Documentation Committee score. Failure rates, as determined by the publishing authors, were recorded for each study. Meta-analyses were conducted using a random-effects model. Paired standardized mean differences (Hedges's g to account for small sample bias) were used for continuous outcome measures, and risk ratios (Mantel-Haenszel method for small sample bias) for dichotomous outcome measures. RESULTS: Six prospective studies satisfied the eligibility criteria and included 249 patients (186 male, 120 female) with an average age of 26.4 years and follow-up of 67.2 months. Tegner scores were superior in patients treated with OAT compared with MFX (ΔOAT-MFX for pre-post scores = 0.94 Tegner points, standardized mean difference [SMD] = 0.469, P = .005). Failure rates of MFX were higher than OAT (OAT = 11%, MFX = 32%, risk ratio = 2.42, P < .036). OAT was superior to MFX at 3 years in relation to subjective outcome scores (SMD = 0.404, P = .008). When assessing OAT lesions larger than 3 cm , OAT was superior to MFX with respect to activity level (SMD = 0.506, P = .001). CONCLUSIONS: OAT may achieve higher activity levels and lower risk of failure when compared with MFX for cartilage lesions greater than 3 cm in the knee, although there was no significant difference for lesions less than 3 cm at midterm. However, because of variability in patient-specific factors such as age, preinjury activity level, lesion location and size, the superiority of OAT over MFX cannot be generalized to all patient populations and therefore requires individualized patient care. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I and II studies.
[Mh] Termos MeSH primário: Artroplastia Subcondral
Transplante Ósseo
Cartilagem Articular/cirurgia
Cartilagem/transplante
Traumatismos do Joelho/cirurgia
[Mh] Termos MeSH secundário: Autoenxertos
Cartilagem Articular/lesões
Seres Humanos
Osteoartrite do Joelho/etiologia
Osteoartrite do Joelho/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160805
[St] Status:MEDLINE


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[PMID]:27436718
[Au] Autor:Beck A; Murphy DJ; Carey-Smith R; Wood DJ; Zheng MH
[Ad] Endereço:Centre for Orthopaedic Research (M508), School of Surgery, University of Western Australia, Crawley, Western Australia, Australia School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia.
[Ti] Título:Treatment of Articular Cartilage Defects With Microfracture and Autologous Matrix-Induced Chondrogenesis Leads to Extensive Subchondral Bone Cyst Formation in a Sheep Model.
[So] Source:Am J Sports Med;44(10):2629-2643, 2016 Oct.
[Is] ISSN:1552-3365
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Microfracture and the autologous matrix-induced chondrogenesis (AMIC) technique are popular for the treatment of articular cartilage defects. However, breaching of the subchondral bone plate could compromise the subchondral bone structure. HYPOTHESIS: Microfracture and AMIC will cause deleterious effects on the subchondral bone structure. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 36 sheep received an 8-mm-diameter cartilage defect in the left medial femoral condyle. Control animals (n = 12) received no further treatment, and the rest received 5 microfracture holes either with a type I/III collagen scaffold implanted (n = 12; AMIC group) or without the collagen scaffold (n = 12; microfracture group). Macroscopic infill of defects, histology, and histomorphometry of the subchondral bone were performed at 13 and 26 weeks postoperatively, and micro-computed tomography (CT) was also performed at 26 weeks postoperatively. RESULTS: Microfracture and AMIC resulted in subchondral bone cyst formation in 5 of 12 (42%) and 11 of 12 (92%) specimens at 13 and 26 weeks, respectively. Subchondral bone changes induced by microfracture and AMIC were characterized by an increased percentage of bone volume, increased trabecular thickness, and a decreased trabecular separation, and extended beyond the area below the defect. High numbers of osteoclasts were observed at the cyst periphery, and all cysts communicated with the microfracture holes. Cartilage repair tissue was of poor quality and quantity at both time points and rarely reached the tidemark at 13 weeks. CONCLUSION: Microfracture technique caused bone cyst formation and induced severe pathology of the subchondral bone in a sheep model. CLINICAL RELEVANCE: The potential of microfracture technique to induce subchondral bone pathology should be considered.
[Mh] Termos MeSH primário: Cartilagem Articular/cirurgia
Condrogênese
Fraturas de Estresse/cirurgia
Articulação do Joelho/cirurgia
[Mh] Termos MeSH secundário: Animais
Artroplastia Subcondral/métodos
Cistos Ósseos/patologia
Colágeno
Colágeno Tipo I
Colágeno Tipo III
Epífises/cirurgia
Feminino
Fêmur/cirurgia
Ovinos
Microtomografia por Raio-X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Collagen Type I); 0 (Collagen Type III); 9007-34-5 (Collagen)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160721
[St] Status:MEDLINE



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