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.
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References
Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007;14(3):177–82.
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.
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.
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.
Versier G, Dubrana F. Treatment of knee cartilage defect in 2010. Orthop Traumatol Surg Res: OTSR. 2011;97(8 Suppl):S140–53.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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Waterman, B., Davey, A., Redondo, M.L., Cole, B.J. (2019). Bipolar Articular Chondral Lesions of the Knee. In: Yanke, A., Cole, B. (eds) Joint Preservation of the Knee. Springer, Cham. https://doi.org/10.1007/978-3-030-01491-9_12
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