Abstract
Introduction
Full-thickness chondral defects at the knee joint predispose to the beginning of a degenerative process which final consequence is the compartment collapse and finally the deviation to varus, because the cartilage of the medial femoral condyle is the most frequently affected area. Likewise, people with these chondral defects are more likely to develop tricompartmental osteoarthritis, reason why early surgical management should be the treatment of choice.
The aim of this study was to compare the pre- and post-operative lower limb alignment (mechanical axis), in cases of full-thickness chondral defects of the femoral medial condyle that have been managed by means of a prosthetic focal inlay resurfacing, at a minimum follow-up of five years.
Methods
A retrospective study of patients treated for chondral defects in the medial femoral condyle was performed. The inclusion criteria were patients who had undergone a focal inlay resurfacing and minimum follow-up of 5 years. Patients that required a concomitant valguizing tibial osteotomy were finally excluded. The follow-up analysis was performed by means of radiological examinations performed prior to surgery and at the last follow-up visit. The mean limb mechanical axis of the operated knees was calculated both pre- and post-operatively, and comparisons between these two settings were performed.
Results
Ten patients were included: eight men and two women. The mean age at the time of surgery was 55 (40–65) years. The mean follow-up was 9 years (range 5–15). The mean limb mechanical axis was 1.33 ± 4.16 in the pre-operative setting and 2.40 ± 5.50 in the post-operative setting (p = 0.441).
Conclusion
In the setting of small to moderate size, unique femoral medial condyle full-thickness chondral lesions, filling the defect with an inlay prosthetic resurfacing may protect against the progression to varus deformity.
Level of evidence
Therapeutic case series, Level IV.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
McCarty EC (2017) Articular cartilage: the search for the holy grail of treatment and restoration. Clin Sports Med 36:xv–xvi
Mandelbaum BR, Elattrache NS (2016) Articular cartilage repair techniques. Sports Med Arthrosc 24:43
Hjelle K, Solheim E, Strand T et al (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18:730–734. https://doi.org/10.1053/jars.2002.32839
Laursen JO, Lind M (2017) Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis. Knee Surg Sport Traumatol Arthrosc 25:746–751. https://doi.org/10.1007/s00167-015-3726-1
Inderhaug E, Solheim E (2019) Osteochondral autograft transplant (Mosaicplasty) for knee articular cartilage defects. JBJS Essent Surg Tech 9:e34. https://doi.org/10.2106/jbjs.st.18.00113
Dhollander AAM, Almqvist KF, Moens K et al (2015) The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair. Knee Surg Sport Traumatol Arthrosc 23:2208–2212. https://doi.org/10.1007/s00167-014-2999-0
Cherian JJ, Kapadia BH, Banerjee S et al (2014) Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications. Curr Rev Musculoskelet Med 7:89–95. https://doi.org/10.1007/s12178-014-9218-y
Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 85-A Suppl 2:58-69. https://doi.org/10.2106/00004623-200300002-00008
Culliton SE, Bryant DM, MacDonald SJ et al (2018) Validity and internal consistency of the new knee society knee scoring system. Clin Orthop Relat Res 476:77–84. https://doi.org/10.1007/s11999.0000000000000014
Roos EM, Klässbo M, Lohmander LS (1999) WOMAC osteoarthritis index. Scand J Rheumatol 28:210–215. https://doi.org/10.1080/03009749950155562
Specogna AV, Birmingham TB, DaSilva JJ et al (2004) Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg 17:203–210. https://doi.org/10.1055/s-0030-1248222
Yoshioka Y, Siu D, Cooke TDV (1987) The anatomy and functional axes of the femur. J Bone Jt Surg Ser A 69:873–880. https://doi.org/10.2106/00004623-198769060-00012
Li CS, Karlsson J, Winemaker M et al (2014) Orthopedic surgeons feel that there is a treatment gap in management of early OA: International survey. Knee Surg Sport Traumatol Arthrosc 22:363–378. https://doi.org/10.1007/s00167-013-2529-5
Corpus KT, Bajaj S, Daley EL et al (2012) Long-term evaluation of autologous chondrocyte implantation: minimum 7-year follow-up. Cartilage 3:342–350. https://doi.org/10.1177/1947603512439460
Gross AE, Kim W, Las Heras F et al (2008) Fresh osteochondral allografts for posttraumatic knee defects: long-term followup. Clin Orthop Relat Res 466:1863–1870. https://doi.org/10.1007/s11999-008-0282-8
Pareek A, Carey JL, Reardon PJ et al (2016) Long-term outcomes after autologous chondrocyte implantation: a systematic review at mean follow-up of 11.4 years. Cartilage 7:298–308. https://doi.org/10.1177/1947603516630786
Bollars P, Bosquet M, Vandekerckhove B et al (2012) Prosthetic inlay resurfacing for the treatment of focal, full thickness cartilage defects of the femoral condyle: A bridge between biologics and conventional arthroplasty. Knee Surg Sport Traumatol Arthrosc 20:1753–1759. https://doi.org/10.1007/s00167-011-1757-9
Becher C, Kalbe C, Thermann H et al (2011) Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee. Arch Orthop Trauma Surg 131:1135–1143. https://doi.org/10.1007/s00402-011-1323-4
Miniaci A (2014) UniCAP as an alternative for unicompartmental arthritis. Clin Sports Med 33:57–65. https://doi.org/10.1016/j.csm.2013.06.002
Brennan SA, Devitt BM, O’Neill CJ, Nicholson P (2013) Focal femoral condyle resurfacing. Bone Joint J 95–B:301–304. https://doi.org/10.1302/0301-620x.95b3.29998
Pascual-Garrido C, Daley E, Verma NN, Cole BJ (2017) A comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthrosc J Arthrosc Relat Surg 33:364–373. https://doi.org/10.1016/j.arthro.2016.07.010
Goebel L, Kohn D, Madry H (2016) Biological reconstruction of the osteochondral unit after failed focal resurfacing of a chondral defect in the knee. Am J Sports Med 44:2911–2916. https://doi.org/10.1177/0363546516654910
Malahias M-A, Chytas D, Thorey F (2018) The clinical outcome of the different HemiCAP and UniCAP knee implants: a systematic and comprehensive review. Orthop Rev (Pavia). https://doi.org/10.4081/or.2018.7531
Becher C, Cantiller EB (2017) Focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee: 12-year follow-up of two cases and review of the literature. Arch Orthop Trauma Surg 137:1307–1317. https://doi.org/10.1007/s00402-017-2717-8
Fuchs A, Eberbach H, Izadpanah K et al (2018) Focal metallic inlay resurfacing prosthesis for the treatment of localized cartilage defects of the femoral condyles: a systematic review of clinical studies. Knee Surg Sport Traumatol Arthrosc 26:2722–2732. https://doi.org/10.1007/s00167-017-4714-4
Acknowledgements
Authors would like to thank the Epidemiology Department of Hospital General de Granollers for their collaboration in the statistical calculations done in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cases, E., Natera, L., Antón, C. et al. Focal inlay resurfacing for full-thickness chondral defects of the femoral medial condyle may delay the progression to varus deformity. Eur J Orthop Surg Traumatol 31, 57–63 (2021). https://doi.org/10.1007/s00590-020-02746-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-020-02746-8