Advertisement

Bipolar Articular Chondral Lesions of the Knee

  • Brian Waterman
  • Annabelle Davey
  • Michael L. Redondo
  • Brian J. ColeEmail author
Chapter

Abstract

Bipolar chondral defects cause a high degree of dysfunction in patients, namely athletes, and are often less common and more difficult to treat than isolated chondral lesions. Patients often present with a more degenerative rather than traumatic etiology, and while bipolar lesions are often a relative contraindication for cartilage procedures, undertreatment may contribute to further degeneration. This is complicated by the relative dearth of literature detailing evidence-based treatment strategies for bipolar lesions. Despite a number of cartilage restoration techniques and orthobiologics available, further research is needed in order to determine the most appropriate and effective treatment for this complicated pathology. This chapter presents two cases of former athletes with symptomatic bipolar lesions – one which was treated with a particulated juvenile allograft cartilage transplantation, microfracture, and tibial tubercle osteotomy with anteromedialization while the other with an osteochondral allograft transplantation, microfracture, and lateral meniscal allograft transplantation.

Keywords

Bipolar lesions Chondral defect Treatment Cartilage lesion 

References

  1. 1.
    Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007;14(3):177–82.CrossRefGoogle Scholar
  2. 2.
    Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456–60.CrossRefGoogle Scholar
  3. 3.
    Spahn G, Fritz J, Albrecht D, Hofmann GO, Niemeyer P. Characteristics and associated factors of Klee cartilage lesions: preliminary baseline-data of more than 1000 patients from the German cartilage registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg. 2016;136(6):805–10.CrossRefGoogle Scholar
  4. 4.
    Solheim E, Krokeide AM, Melteig P, Larsen A, Strand T, Brittberg M. Symptoms and function in patients with articular cartilage lesions in 1,000 knee arthroscopies. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1610–6.CrossRefGoogle Scholar
  5. 5.
    Versier G, Dubrana F. Treatment of knee cartilage defect in 2010. Orthop Traumatol Surg Res: OTSR. 2011;97(8 Suppl):S140–53.CrossRefGoogle Scholar
  6. 6.
    Lonner JH, Hershman S, Mont M, Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res. 2000;380:85–90.CrossRefGoogle Scholar
  7. 7.
    Cahue S, Dunlop D, Hayes K, Song J, Torres L, Sharma L. Varus-valgus alignment in the progression of patellofemoral osteoarthritis. Arthritis Rheum. 2004;50(7):2184–90.CrossRefGoogle Scholar
  8. 8.
    Sharma L, Song J, Dunlop D, et al. Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis. 2010;69(11):1940–5.CrossRefGoogle Scholar
  9. 9.
    Bhosale AM, Myint P, Roberts S, et al. Combined autologous chondrocyte implantation and allogenic meniscus transplantation: a biological knee replacement. Knee. 2007;14(5):361–8.CrossRefGoogle Scholar
  10. 10.
    Harris JD, Hussey K, Saltzman BM, et al. Cartilage repair with or without meniscal transplantation and osteotomy for lateral compartment chondral defects of the knee: case series with minimum 2-year follow-up. Orthop J Sports Med. 2014;2(10):2325967114551528.CrossRefGoogle Scholar
  11. 11.
    Ogura T, Bryant T, Minas T. Biological knee reconstruction with concomitant autologous chondrocyte implantation and meniscal allograft transplantation: mid- to long-term outcomes. Orthop J Sports Med. 2016;4(10):2325967116668490.CrossRefGoogle Scholar
  12. 12.
    Cantin O, Lustig S, Rongieras F, et al. Outcome of cartilage at 12years of follow-up after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res: OTSR. 2016;102(7):857–61.CrossRefGoogle Scholar
  13. 13.
    Chalmers PN, Mall NA, Moric M, et al. Does ACL reconstruction alter natural history?: a systematic literature review of long-term outcomes. J Bone Joint Surg Am. 2014;96(4):292–300.CrossRefGoogle Scholar
  14. 14.
    Ringler MD, Shotts EE, Collins MS, Howe BM. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI. Skelet Radiol. 2016;45(12):1695–703.CrossRefGoogle Scholar
  15. 15.
    Zhang GY, Zheng L, Shi H, Ji BJ, Feng Y, Ding HY. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: correlation analysis with anatomical variants and articular cartilage lesion of the patella. Eur Radiol. 2017;27(3):1322–30.CrossRefGoogle Scholar
  16. 16.
    Riboh JC, Cole BJ, Farr J. Particulated articular cartilage for symptomatic chondral defects of the knee. Curr Rev Musculoskelet Med. 2015;8(4):429–35.CrossRefGoogle Scholar
  17. 17.
    Chu CR, Convery FR, Akeson WH, Meyers M, Amiel D. Articular cartilage transplantation. Clinical results in the knee. Clin Orthop Relat Res. 1999;360:159–68.CrossRefGoogle Scholar
  18. 18.
    Fischer M, Koller U, Krismer M. The use of fresh allografts in osteochondrosis dissecans of the lateral femoral condyle. Oper Orthop Traumatol. 2006;18(3):245–58.CrossRefGoogle Scholar
  19. 19.
    Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br. 1997;79(6):1008–13.CrossRefGoogle Scholar
  20. 20.
    Meric G, Gracitelli GC, Gortz S, De Young AJ, Bugbee WD. Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee. Am J Sports Med. 2015;43(3):709–14.CrossRefGoogle Scholar
  21. 21.
    Lee BS, Bin SI, Kim JM, Kim WK, Choi JW. Survivorship after meniscal allograft transplantation according to articular cartilage status. Am J Sports Med. 2017;45(5):1095–101.CrossRefGoogle Scholar
  22. 22.
    Gobbi A, Karnatzikos G, Kumar A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):1986–96.CrossRefGoogle Scholar
  23. 23.
    Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc. 2005;13(3):213–21.CrossRefGoogle Scholar
  24. 24.
    Chahla J, Dean CS, Moatshe G, Pascual-Garrido C, Serra Cruz R, LaPrade RF. Concentrated bone marrow aspirate for the treatment of chondral injuries and osteoarthritis of the knee: a systematic review of outcomes. Orthop J Sports Med. 2016;4(1):2325967115625481.CrossRefGoogle Scholar
  25. 25.
    Kon E, Buda R, Filardo G, et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):472–9.CrossRefGoogle Scholar
  26. 26.
    Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med. 2016;44(11):2846–54.CrossRefGoogle Scholar
  27. 27.
    Siclari A, Mascaro G, Kaps C, Boux E. A 5-year follow-up after cartilage repair in the knee using a platelet-rich plasma-immersed polymer-based implant. Open Orthop J. 2014;8:346–54.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Brian Waterman
    • 1
  • Annabelle Davey
    • 2
  • Michael L. Redondo
    • 3
  • Brian J. Cole
    • 3
    Email author
  1. 1.Wake Forest School of MedicineWinton-SalemUSA
  2. 2.University of Vermont, College of MedicineBurlingtonUSA
  3. 3.Department of Orthopedic SurgeryRush University Medical CenterChicagoUSA

Personalised recommendations