Introduction. Osteochondral lesions of the talus are common injuries following acute and chronic ankle sprains and fractures, the treatment strategies of which include both reparative and restorative techniques. Recently, restorative techniques (i.e., autologous osteochondral transplantation) have been become increasingly popular as a primary treatment strategy, in part due to the potential advantages of replacing “like with like” in terms of hyaline cartilage at the site of cartilage repair. The current study examines the functional results of autologous osteochondral transplantation of the talus in 72 patients. Methods. Between 2005 and 2009, 72 patients underwent autologous osteochondral transplantation under the care of the care of the senior author. The mean patient age at the time of surgery was 34.19 years (range, 16–85 years). The mean follow-up time was 28.02 months (range, 12–64 months). Patient-reported outcome measures were taken pre-operatively and at final-follow-up using the Foot and Ankle Outcome Score and Short-Form 12 general health questionnaire. Quantitative T2-mapping MRI was also performed on select patients at 1-year post-operatively. Results. The mean FAOS scores improved from 52.67 points pre-operatively to 86.19 points post-operatively (range, 71–100 points). The mean SF-12 scores also improved from 59.40 points pre-operatively to 88.63 points post-operatively (range, 52–98 points). Three patients reported donor site knee pain after surgery. Quantitative T2-mapping MRI demonstrated relaxation times that were not significantly different to those of native cartilage in both the superficial and deep halves of the repair tissue. Discussion and Conclusion. Autologous osteochondral transplantation is a reproducible and primary treatment strategy for large osteochondral lesions of the talus and provides repair tissue that is biochemically similar to that of native cartilage on quantitative T2-mapping MRI. This may ultimately allow the ankle joint to function adequately over time

We describe the outcome at a mean follow-up of 8.75 years (7.6 to 9.8) of seven patients who had undergone osteochondral autologous transplantation for full-thickness cartilage defects of the shoulder between 1998 and 2000. These patients have been described previously at a mean of 32.6 months when eight were included. One patient has been lost to follow-up. The outcome was assessed by the Constant shoulder score and the Lysholm knee score to assess any donor-site morbidity. Standard radiographs and MR scores were obtained and compared with the pre-operative findings and the results from the previous review. No patient required any further surgery on the shoulder. The mean Constant score improved significantly until the final follow-up (p = 0.018). The Lysholm score remained excellent throughout. There was a significant progression of osteoarthritic changes from the initial surgery to the first and final follow-up but this did not appear to be related to the size of the defect, the number of cylinders required or the Constant score (p = 0.016). MRI showed that all except one patient had a congruent joint surface at the defect with full bony integration of all osteochondral cylinders. The results have remained satisfactory over a longer period with very good objective and subjective findings

We performed eight osteochondral autologous transplantations from the knee joint to the shoulder. All patients (six men, two women; mean age 43.1 years) were documented prospectively. In each patient the stage of the osteochondral lesion was Outerbridge grade IV with a mean size of the affected area of 150 mm. 2. All patients were assessed by using the Constant score for the shoulder and the Lysholm score for the knee. Standard radiographs, magnetic resonance imaging and second-look arthroscopy were used to assess the presence of glenohumeral osteoarthritis and the integrity of the grafts. After a mean of 32.6 months (8 to 47), the mean Constant score increased significantly. Magnetic resonance imaging revealed good osseointegration of the osteochondral plugs and congruent articular cartilage at the transplantation site in all but one patient. Second-look arthroscopy performed in two cases revealed a macroscopically good integration of the autograft with an intact articular surface. Osteochondral autologous transplantation in the shoulder appears to offer good clinical results for treating full-thickness osteochondral lesions of the glenohumeral joint. However, our study suggests that the development of osteoarthritis and the progression of pre-existing osteoarthritic changes cannot be altered by this technique

The October 2024 Knee Roundup. 360. looks at: Managing the unexpected: treatment of intraoperative medial collateral ligament injuries; Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: secondary analysis of data from a randomized controlled trial; Cost-effectiveness of enoxaparin versus aspirin in the prevention of venous thromboembolism after total hip or knee arthroplasty: an analysis from the CRISTAL cluster-randomized trial; Cartilage regeneration and long-term survival in medial knee osteoarthritis patients treated with high tibial osteotomy and osteochondral autologous transfer system; Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes; Long-term outcomes of multiligament knee injuries in American football players

Autologous osteochondral transplantation (AOT) is an effective treatment for large Osteochondral Lesions of the Talus (OLT), however little is reported on an athletic population, who are likely to place higher demands on the reconstruction. The aim is to report the outcomes of large OLT (>150mm. 2. ) within an athletic population. The study population was limited to professional or amateur athletes (Tegner score >6) with an OLT of size 150mm. 2. or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included Return to Sport, VAS and FAOS Scores. In addition, graft incorporation was evaluated by MRI using MOCART scores at 12 months post-surgery. 38 athletes including 11 professional athletes were assessed. Mean follow-up was 46 months. Mean lesion size was 249mm. 2. 33 patients returned to sport at their previous level and one did not return to sport (mean return to play 8.2 months). Visual analogue scores improved from 4.53 pre-operatively to 0.63 post-operatively (p=0.002). FAOS Scores improved significantly in all domains (p< 0.001). Two patients developed knee donor site pain, and both had three osteochondral plugs harvested. Univariant analysis demonstrated no association between pre-operative patient or lesion characteristics and ability to return to sport. However, there was a strong correlation between MOCART scores and ability to return to sport (AUC=0.89). Our study suggests that AOT is a viable option in the management of large osteochondral talar defects in an athletic population, with favourable return to sport levels, patient satisfaction, and FAOS/VAS scores. The ability to return to sport is predicated upon good graft incorporation and further research is required to optimise this technique. Our data also suggests that patients should be aware of the increased risk of developing knee donor site pain when three osteochondral plugs are harvested

Introduction. The purpose of this study was to examine trends in patient characteristics and clinical outcomes that occur with age as a statistical variable when performing autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesions of the talus (OLT). Methods. A retrospective cohort study for AOT procedures on 78 patients from 2006 to 2019. was conducted Clinical outcomes were evaluated via FAOS scores. A multivariable linear regression was used to assess the independent factors predictive of the first post-operative FAOS after AOT. The independent variables included pre-operative FAOS, age, defect size, shoulder lesion, cystic lesion, prior traumatic injury, and history of microfracture surgery. A p-value <.05 was considered significant and 95% confidence limits (95% CL) for regression coefficient estimates (est.) were calculated. Results. 78 patients were included with a mean age of 35.5 ± 13.6years at a mean follow-up was 54.4 ± 18.9 months. The mean pre-operative FAOS was 54.3 ± 19.4 and the mean post-operative FAOS was 83.4 ± 13.6. The mean defect size was 109.3±62.4 mm2. The multivariable linear regression showed that the pre-operative FAOS was associated with a higher post-operative FAOS (est., 95% CL: 0.16, 0.012 – 0.307; p=0.034). Defect size (est., 95% CL: −0.05, −0.097 – −0.003; p=0.0358), having a shoulder lesion (est., 95% CL: −9.068, −15.448 – −2.688; p=0.006), or having a prior microfracture surgery (est., 95% CL: −7.07, −13.118 – −1.021; p=0.0226) were associated with a lower post-operative FAOS. Conclusion. Patient age was not an independent risk factor for inferior clinical outcomes after AOT for OLT. Additionally, cystic lesions, or lesions with a traumatic aetiology were not significantly associated with post-operative FAOS. Having a shoulder lesion had the largest marginal effect on post-operative FAOS. These findings provide important information for providers when counseling and selecting patients for AOT procedure for treatment of OLT

Purpose of study: To investigate and compare the characteristics of the reconstructed articular surface microscopically and histologically after a time period of 6 weeks following the treatment of a focal defect of the right femoral head with subchondral drilling and autologous osteochondral transplantation in rabbits. Material and method: A 2,5 mm diameter and 3 mm depth iatrogenic osteochondral defect in the anterolateral weight bearing area of the right femoral head was created in 12 rabbits. In a group of 6 rabbits the lesion was treated with autologous osteochondral transplantation. The donor site for the transplant was the lateral condyle of the ipsilateral knee joint. The other group of 6 rabbits was treated with subchondral drilling. Both groups were sacrificed after a time period of 6 weeks and specimens were evaluated histologically under the classification system of the ICRS. For statistical analysis we used the Mann – Wittney test. Results: According to the ICRS score statistical significance was found for all variables between the 2 groups (subchondral drilling 6 weeks vs autologous osteochondral transplantation 6 weeks).: articular surface (p=0,049), matrix (p=0,003), cell distribution (p< 0,0005), subchondral bone (p=0,010), cartilage mineralization (p=0,0) except cell population viability. Discussion: In comparison to subchondral drilling, autologous osteochondral transplantation provided better results concerning the smoothness and continuity of the articular surface, the consistency of the matrix with dominance of the hyaline and mixed hyaline – fibrocartilage type of tissue, the normality of subchondral bone and the columna r distribution of cells. The viability of the cell populations was the same for both methods. The incorporation of the osseous part of the graft was successful in all cases and the surgical procedure did not produce any necrosis of the femoral head. Conclusion: In cases of focal osteochondral defect of the femoral head in rabbits, reconstruction of the articular surface through autologous osteochondral graft transplantation gives superior macroscopical and histological results in comparison to subchondral drilling

Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation. . Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus. . Cite this article: Bone Joint J 2014;96-B:164–71

Aim of study: Comparison of clinical and radiological results of the applied methods. Material and method: 20 patients with osteochondritis dissecans of the talus were treated. Autologous chondrocyte transplantation was applied to a group of 10 patients (Group A) and autologous osteochondral transplantation to the rest 10 patients (Group B).Group A: Average-age=30,8 years, -follow up time= 33,6 (12–48) months, -lesion size= 20×16,2 (35–15 × 25–15) mm and depth =7 (20–5) mmGroup B: Average –age =33, 7 years, follow up time =32,4 (12–48) months, – lesion size=16,5×15 (25–10 × 20–10) mm and depth=4 (5–3) mm.All patients underwent clinical und radiological investigation and the symptoms were classified in accordance with the Finsen classification. Group A was treated with autologous chondrocyte and Group B with autologous osteochondral transplantation. Osteotomy of the medial or lateral malleolus was necessary by 6 Group A – patients and 4 Group B – patients. Postoperative treatment : Non-weight bearing for 6 weeks, continuous passive motion of the joint, clinical and radiological follow up 3rd, 6th, 12th and yearly basis. Results: Postoperatively the average Finsen score showed for Group A an improvement from 3,5 (very bad) to 1,1 (excellent) and for Group B from 3,6 (very bad) to 1 (excellent). MRI follow up showed defect coverage by 7 patients of Group A and 9 patients of Group B after 12 months. Second look arthroscopy was performed by 4 patient of Group A and 3 patients of Group B showing full coverage of the defect site. Complications: persisting swelling for an average time of 2,7 months in Group A and 4,3 months in Group B. Additionally 10 degrees loss of joint extension in 4 patients of Group A and 3 patients of Group B. Conclusion: Autologous chondrocyte transplantation as well as autologous osteochondral transplantation present very good clinical results. As methods of articular surface restoration they have their advantages and disadvantages playing an important role in chosing one of them, in combination always with the surgeons philosophy. The existence of these methods is important in influencing the course of the ankle joint towards a good prognosis, in cases of osteochondral lesion. Further investigation is necessary

Purpose of study: To search and analyse the results of autologous osteochondral transplantation on patients with osteochondritis dissecans of the talus. Material and method: From 1997 until 2000, 10 patients with 3dr to 4th degree osteochonditis dissecans of the taus were treated with autologous osteochondral transplantation. Their average: age was 33,7 years, and follow up time:32,4 months. Clinical evaluation in accordance with the Finsen classification system as well as radiological evaluation was conducted. Afterwards arthroscopy with transplantation of autologous osteochondral grafts was performed. An osteomy of the medial malleolus was necessary by 4 patients. Non weight bearing and continuous passive motion for 6 weeks was advised. Results: The average Finsen score showed improvement: From 3,6 preoperatively to 1 (excellent) postoperatively. Full coverage of the defects was observed at 12 month follow up with MRI in 9 patients and arthoscopically in 3 patients. Conclusion: This method of treatment presents very good clinical results and sends a hopefull message on the prognosis of the ankle joint in cases of osteochondral damage

Cite this article: Bone Joint Res 2024;13(12):790–792.

Osteocondritis dissecans (OCD) is a relatively common cause of knee pain. Ideal treatment is still controversial. Aim of this exhibit is to describe the outcomes of 5 different surgical techniques in a series of 63 patients. 63patients (age 22.5±7.4 years) affected by OCD of the femoral condyle (45 medial and 17 lateral) were treated by either osteochondral autologous transplantation, autologous chondrocyte implantation with bone graft, biomimetic nanostructured osteochondral scaffold (Maioregen) implantation, bone-cartilage paste graft or bone marrow derived cells transplantation “one-step” technique. Patient evaluation included IKDC score, eq-vas score, X-Rays and MRI preoperatively and at follow-up. Global mean IKDC improved from pre-operative 40.1±14.6 to 77.2±21.3 (p<0.0005) at mean 5.3±4.7 years follow-up, while eq-vas improved from 51.7±17.0 to 83.5±18.3(p<0.0005). No influence of age, size of the lesion, length of follow-up and associated surgeries on the result was found. No differences were found between the results obtained with different surgeries except a slight tendency of better improvement in the result following autologous chondrocyte implantation (p<0.01). Control MRI evidenced a satisfactory repair of cartilaginous layer and subchondral bone. The techniques described were effective in providing good clinical and radiographic results in the treatment of OCD and confirmed the validity of autologous chondrocyte implantation over time. Newer techniques such as Maioregen implantation and “one-step” base on different rationales, the first relying on the characteristics of the scaffold and the second on the regenerative potential of mesenchymal cells. Both of them have the advantages to be minimally invasive surgeries and to require a single operation

Measurement of precision in positioning multiple autologous osteochondral transplantation in comparison to the conventional free hand technique. The articular surfaces of 6 cadaveric condyles (medial – lateral) were used. The knee was referenced by a navigation system (Praxim). The pins carrying the navigation detectors were positioned to the femur and to the tibia. The grafts were taken from the donor side (measurement I) with the special instrument which carried the navigation detectors. The recipient site was prepared and the donor osteochondral grafts were forwarded to the articular surface (II). The same procedure took place without navigation. The articular surface congruity was measured with the probe (measurement III). The angle of the recipient plug removal (measurement I) with the navigation technique was 3,27° (SD 2,05°; 0°–9°). The conventional technique showed 10,73° (SD 4,96°; 2°–17°). For the recipient plug placement (measurement II) under navigated control a mean angle of 3,6° (SD 1,96°; 1°–9°) was shown, the conventional technique showed results with a mean angle of 10,6° (SD 4,41°; 3°–17°). The mean depth (measurements III) under navigated control was 0,25mm (SD 0,19mm; 0mm–0,6mm). With conventional technique the mean depth was 0,55mm (SD 0,28mm; 0,2mm –1,1mm). The application of navigation showed that complications like diverging of the grafts leading to breakage or loosening as well as depth mismatch which can lead to grafts sitting over or under the articular surface can be avoided providing better results in comparison to the free hand procedure

Aims: To evaluate clinical and radiological results and to present variant of possible mosaicplasty application for treatment of large osteochondral defects. Methods: Between 1998 and 2001, seven patients were operated on with a large osteochondral defect of the femoral condyle using the cylindrical grafts. The age of the þve male and two female ranged from 19 to 27 years. Initially all of them suffered from an osteochondrosis dissecans which was located at the typical site on the medial condyle of the femur. A cylindrical graft is taken from the medial rim of the femoral trochlea, away from femoropatellar weight-bearing areas, with a cylindrical cutter of the 6–11 mm diameter. The hole of recipient site is prepared with a same cutter less by 1 mm diameter. A next graft is inserted in the same way and can cross from preceding graft. The procedure is repeated 2–3 times. The grafts should cover at least 90% of the cartilage defect. Results: The follow-up study was from 1 to 3 years and showed an improvement from 37 points preoperatively to 87 points postoperatively (Cincinnati knee score). All patients returned to there previous professions as well as mild sports activity. Conclusions: For the operative treatment of large chondral defects at the femoral condyle autologous osteochondral transplantation using the cylindrical grafts with mosaicplasty seems to be a successful alternative

Osteochondral autologous transplantation (OATS) is a new technique for the treatment of osteochondral defects. In a prospective study between April 1996 und May 2001 we used the OATS technique to treat 201 patients (125 male, 76 female) with a mean osteochondral defect of 3,3 cm. 2. The defect was in the medial femoral condyle in 96 cases, the lateral femoral condyle in 16, the patella in 22, the trochlea in seven, the tibial plateau in one, the talus in 48, the tibial plafond in two and capitellum in four. There were 17 other locations. The procedure was performed either open or arthroscopically. A mean of 2,2 cylinders was transplanted. The Lysholm score in the lower limbs increased from a preoperative mean of 58,3 (20 to77) to a mean of 90,2 (70 to 100). Treatment by OATS alone increased the score from 65,2 to 91,6. With additional ACL/PCL reconstruction, the score increased from 49,9 to 82,6. The combination of OATS, HTO, ACL/PCL reconstruction increased the Lysholm score from 55,5 to 85,5. Ten per cent of patients complained of pain at the donor site in the lateral femoral condyle. There were no complications related to OATS performed in the upper limbs, and control MRI three months postoperatively showed incorporation of all cylinders. The results are encouraging, and give rise, to the hope that this cost-effective and safe treatment for limited osteochondral defects may delay or even prevent the onset of osteoarthritis

Full-thickness chondral defects of weight-bearing articular surfaces of the knee are a difficult condition to treat. Our aim is to evaluate the mid- and long-term functional outcome of the treatment of osteochondral defects of the knee with autologous osteochondral transplantation with the OATS technique. Thirty-six patients (37 procedures) were included in this study. Twenty-three patients were male and 13 female with a mean age of 31,9 years (range: 18 to 48 years). The cause of the defect was OCD in 10 cases, AVN in 2, lateral patellar maltracking in 7, while in the remaining 17 patients the defect was post-traumatic. The lesion was located on the femoral condyles in 26 cases and the patellofemoral joint in the remaining 11. The average area covered was 2,73cm2 (range: 0,8 to 12cm2) and patients were followed for an average of 36,9 months (range: 18–73 months). The average score in their Tegner Activity Scale was 3,76 (range: 1–8), while their score in Activities of Daily Living Scale of the Knee Outcome Survey ranged from 18 to 98 with an average of 72,3. Thirty-two out of 37 patients (86,5%) reported improvement of their pre-operative symptoms. All but 5 patients returned to their previous occupation while 18 went back to sports. No correlation was found between patient age at operation, the size or site of the chondral lesion and the functional outcome. We believe that autologous osteochondral grafting with the OATS technique is a safe and successful treatment option for focal osteochondral defects of the knee. It offers a very satisfactory functional outcome and does not compromise in any way patients’ future options

Knee trauma often causes meniscal injuries. Only 15% of all tears can be repaired. Partial or complete meniscectomy subsequently leads to an increased incidence of chondral damage and onset of early osteoarthritis. In Europe in 1999, 355 000 meniscal injuries were treated, 284 000 of which required partial or complete meniscectomy. As an alternative to allograft, the collagen meniscus implant (CMI®) can be used for reconstruction. A collagen matrix moulded in the form of a meniscus, this is trimmed to defect size and sutured into place arthroscopically. It then serves as a scaffold for cellular invasion. Indications are tears that require partial meniscectomy or an intact remnant stable meniscus. Cruciate ligament injuries, malalignment, osteoarthritis and stage-IV osteochondral defects are the principal contraindications. Between July 1998 and March 2000, 10 patients received a CMI in our department. Additional pathologies (four anterior cruciate ligament (ACL) injuries, four varus malalignments and five chondral defects) were treated simultaneously. The Lysholm score increased from 70 to 99 in patients treated with an additional high tibial osteotomy (HTO), from 58 to 91 in the group with ACL reconstruction, from 71 to 93 in patients with osteochondral autologous transplantation (OATS). The Lysholm score of the combined group (two patients with HTO and OATS, two with HTO and ACL reconstruction) improved from a preoperative 69 to 99 postoperatively. CMI, a biocompatible resorbable implant, induces cellular ingrowth and arthroscopic implantation. However, there are still questions to be answered. Few cases have been reported and no long-term studies have yet been published. It is not yet known whether osteochondral defects, unstable joints or malignment are limitations of using the implants

Objective. To provide a best estimate of the average treatment effect when microfracture was chosen as the intervention of choice in patients with full-thickness cartilage defects of the knee. Design. We focussed on controlled studies which either referred to microfracture alone or in comparison with any other surgical treatment of articular cartilage of the knee. Papers including patients who had been treated by microfracture and concomitant adjuvant procedures like ACL reconstruction or meniscus repair were accepted too, whereas papers reporting on the microfracture technique combined with the implantation of a scaffold were excluded. To achieve a best estimate of the average, to be expected treatment effect we pooled pooled before–after data of study arms using microfracture. Because cartilage studies employ various scales to measure functional improvements, we standardized treatment effects using Hedges' g. To provide clinically meaningful estimates we converted the pooled summary effect back into the respective scales by multiplying the pooled effect with pooled standard deviations of each included clinical scale. Results. A systematic review of the literature revealed six papers including 200 patients with a mean age of 32 years, a mean defect size of 3 cm. 2. and a follow up period from 2 to 5 years. Four of the studies compared microfracture to autologous chondrocyte implantation and two of them to osteochondral autologous transplantation. All patients were treated by the microfracture technique as described by Steadman and by a similar rehabilitation protocol which only allowed crutch-assisted touchdown weight bearing initially. Referring to the individual studies, a comparison of the pooled estimates of Hedges' g revealed that the two papers which evaluated the youngest patients provided the highest treatment effect. On the contrary, those two papers which focussed on the largest lesions, reported the worst improvement. Finally, the remaining two papers whose patients were characterized by similar age and defect size presented comparable results. The individual standardized effect sizes were combined into an overall best estimate. Its value was 1.678, measured in units of standard deviation, with the 95% confidence interval of [1.016; 2.340] resulting in different values of the average, to be expected treatment effect when it is measured in Lysholm Score (22.1), IKDC Score (26.5) and KOOS (15.2) points. Conclusions. Our results offer a clinically intuitive estimation of the average treatment effects on common clinical scales. Compared to the preoperative situation, a significant clinical improvement can be expected for each patient. Nevertheless, the magnitudes of these treatment effects are an approximation and must be interpreted cautiously. Furthermore, we did not succeed to confirm that young age and small lesion size have a beneficial effect on the clinical outcome

Introduction Osteochondral autologous transplantation (OATS) is a technique to treat hyaline cartilage injuries in different joints. It delivers high quality hyaline cartilage to the defect. Methods In a prospective study we used the OATS technique in 201 patients (125 male, 76 female). The mean defect size was 3.3 sq cm. The medial femoral condyle was treated in 96 cases, the lateral femoral condyle in 16, the patella in 22, the trochlea in seven, the tibial plateau in one, the talus in 48, the tibial plafond in two and the capitellum in four. There were 17 other locations. The procedure was performed either open or arthroscopically. A mean of 2.2 cylinders were implanted. Mal-alignment was corrected in 20 cases with an osteotomy and instability of the knee by anterior (ACL) or posterior (PCL) reconstruction. Five patients required reconstruction of both the ACL and PCL. Results The Lysholm score increased from 58.3 (20 to 77) to a mean of 90.2 (70 to 100) in the lower extremity. Treatment by OATS alone increased the score from 65.2 to 91.6. With additional ACL/PCL reconstruction, the score increased from 49.9 to 82.6. The combination of OATS, HTO and ACL/PCL reconstruction increased the Lysholm score from 55.5 to 85.5. Post-operative MR imaging with intravenous contrast showed incorporation of all but one cylinder. Complications included one case of arthrofibrosis and sinking of one cylinder. One patient developed regional pain syndrome and three had pain at the malleolar osteotomy site resolved by screw removal. Ten percent of the patients developed pain at the donor site. Conclusions The results are encouraging. It is a cost effective and safe treatment

Aim: CMI was designed to support regeneration of the meniscus and to improve symptoms in patients after meniscectomy. We use CMI for meniscal replacement in patients with multiple knee problems in combination with other reconstructive procedures. Methods: Eleven patients (4f, 7m), average age 36 years (24–56 y.), were included in the prospective evaluation with minimum follow-up of 12 months (mean 24.5 mo, range 13–38 mo). Ten patients had previous surgeries (9 meniscectomies, 4 ACL reconstructions). CMI transplantation was performed in combination with HTO (n=6), ACL reconstruction (n=4) and autologous osteochondral transplantation (OATS) (n=6). Additional to a clinical evaluation, 6 patients underwent a diagnostic arthroscopy and biopsy. Results: Pain scores reduced from 5.4±1.3 to 2.3±0.7 (VAS 1=no pain, 10=worst pain). The knee function was evaluated B (nearly normal) in all patients. Lysholm score increased from 70 to 94 in patients with CMI/HTO, respectively 58 to 91 in patients with CMI/ACL and 71 to 93 in patients with CMI/OATS. Arthroscopic views demonstrated good integration and intact CMI implants especially in the middle and anterior parts of the menisci. Histological findings showed interstitial spaces of the matrix filled with fibrous matrix and oval cells resembling fibrochondrocytes in some regions. Conclusions: The results of arthroscopy, histology and the good clinical outcome support our treatment philosophy addressing all knee pathologies at once. CMI can be included in combined knee procedures, since the integration and generation of a new meniscus are improved with re-established articular surface and knee alignment