Full thickness cartilage defects of the femoral condyles are frequent, can be highly symptomatic, and pose treatment challenges when encountered in middle-aged patients. A history of biological repair procedures is frequent and patient management is complex in order to delay joint replacement procedures in active patients. Focal metallic resurfacing provides a joint preserving bridging procedure with a clinical exit into primary arthroplasty. This study presents a review of several multicenter investigations exploring the clinical benefits and validity of focal resurfacing in 78 patients, ages 35–67, with a follow-up ranging from 2 to 6 years. All patients were treated with a 15 or 20 mm contoured resurfacing implant on the medial or lateral femoral condyle. At 2 years follow up, average scores for WOMAC domains improved by over 100% (40 preop to 86 postop where 100 = best). At 3 year follow-up KOOS scores were within 88 to 102% of a normal aged matched population (domain range 72–91 where 100 = best). At a minimum of 5 years, the KOOS domains were close to normative reference levels on pain relief, symptoms, and activities of daily living (range 83–89% of normal). Radiographic results demonstrated solid fixation, preservation of joint space, and no change in the osteoarthritic stage.Methods.
Results.
The presence of a Hill-Sachs lesion is a major contributor to failure of surgical intervention following anterior shoulder dislocation. The relationship between lesion size, measured on pre-operative MRI, and risk of recurrent instability after surgery has not previously been defined. Hypothesis: We hypothesized that the size of Hill-Sachs lesions on pre-op MRI would be greater among patients who failed soft tissue stabilization when compared to patients who did not fail. We also hypothesized that the existence of a glenoid lesion would lead to failure with smaller Hill-Sachs lesions. Nested case-control analysis of 114 patients was performed to evaluate incidence of failure after soft tissue stabilization. Successful follow-up of at least 24 months was made with 91 patients (80%). Patients with recurrent instability after surgery were compared to randomly selected age and sex matched controls in a 1:1 ratio. Pre-operative sagittal and axial MRI series were analyzed for presence of Hill-Sachs lesions, and maximum edge-to-edge length and depth as well as location of the lesion related to the bicipital groove (axial) and humeral shaft (sagittal) were measured.Purpose
Method
