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Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years

PURPOSE: Surgical treatment options for the management of focal chondral and osteochondral lesions in the knee include biological solutions and focal metal implants. A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or who have failed prior cartilage r...

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Autores principales: Holz, Johannes, Spalding, Tim, Boutefnouchet, Tarek, Emans, Pieter, Eriksson, Karl, Brittberg, Mats, Konradsen, Lars, Kösters, Clemens, Verdonk, Peter, Högström, Magnus, Lind, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384793/
https://www.ncbi.nlm.nih.gov/pubmed/33025052
http://dx.doi.org/10.1007/s00167-020-06289-7
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author Holz, Johannes
Spalding, Tim
Boutefnouchet, Tarek
Emans, Pieter
Eriksson, Karl
Brittberg, Mats
Konradsen, Lars
Kösters, Clemens
Verdonk, Peter
Högström, Magnus
Lind, Martin
author_facet Holz, Johannes
Spalding, Tim
Boutefnouchet, Tarek
Emans, Pieter
Eriksson, Karl
Brittberg, Mats
Konradsen, Lars
Kösters, Clemens
Verdonk, Peter
Högström, Magnus
Lind, Martin
author_sort Holz, Johannes
collection PubMed
description PURPOSE: Surgical treatment options for the management of focal chondral and osteochondral lesions in the knee include biological solutions and focal metal implants. A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or who have failed prior cartilage repair surgery. This study reports on the early clinical and functional outcomes in patients undergoing treatment with an individualised mini-metal implant for an isolated focal chondral defect in the knee. METHODS: Open-label, multicentre, non-randomised, non-comparative retrospective observational analysis of prospectively collected clinical data in a consecutive series of 80 patients undergoing knee reconstruction with the Episealer® implant. Knee injury and Osteoarthritis Outcome Score (KOOS) and VAS scores, were recorded preoperatively and at 3 months, 1 year, and 2 years postoperatively. RESULTS: Seventy-five patients were evaluated at a minimum 24 months following implantation. Two patients had undergone revision (2.5%), 1 declined participation, and 2 had not completed the full data requirements, leaving 75 of the 80 with complete data for analysis. All 5 KOOS domain mean scores were significantly improved at 1 and 2 years (p < 0.001–0.002). Mean preoperative aggregated KOOS4 of 35 (95% CI 33.5–37.5) improved to 57 (95% CI 54.5–60.2) and 59 (95% CI 55.7–61.6) at 12 and 24 months respectively (p < 0.05). Mean VAS score improved from 63 (95% CI 56.0–68.1) preoperatively to 32 (95% CI 24.4–38.3) at 24 months. The improvement exceeded the minimal clinically important difference (MCID) and this improvement was maintained over time. Location of defect and history of previous cartilage repair did not significantly affect the outcome (p > 0.05). CONCLUSION: The study suggests that at 2 years, Episealer® implants are safe with a low failure rate of 2.5% and result in clinically significant improvement. Individualised mini-metal implants with appropriate accurate guides for implantation appear to have a place in the management of focal femoral chondral and osteochondral defects in the knee. LEVEL OF EVIDENCE: IV.
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spelling pubmed-83847932021-09-09 Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years Holz, Johannes Spalding, Tim Boutefnouchet, Tarek Emans, Pieter Eriksson, Karl Brittberg, Mats Konradsen, Lars Kösters, Clemens Verdonk, Peter Högström, Magnus Lind, Martin Knee Surg Sports Traumatol Arthrosc Knee PURPOSE: Surgical treatment options for the management of focal chondral and osteochondral lesions in the knee include biological solutions and focal metal implants. A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or who have failed prior cartilage repair surgery. This study reports on the early clinical and functional outcomes in patients undergoing treatment with an individualised mini-metal implant for an isolated focal chondral defect in the knee. METHODS: Open-label, multicentre, non-randomised, non-comparative retrospective observational analysis of prospectively collected clinical data in a consecutive series of 80 patients undergoing knee reconstruction with the Episealer® implant. Knee injury and Osteoarthritis Outcome Score (KOOS) and VAS scores, were recorded preoperatively and at 3 months, 1 year, and 2 years postoperatively. RESULTS: Seventy-five patients were evaluated at a minimum 24 months following implantation. Two patients had undergone revision (2.5%), 1 declined participation, and 2 had not completed the full data requirements, leaving 75 of the 80 with complete data for analysis. All 5 KOOS domain mean scores were significantly improved at 1 and 2 years (p < 0.001–0.002). Mean preoperative aggregated KOOS4 of 35 (95% CI 33.5–37.5) improved to 57 (95% CI 54.5–60.2) and 59 (95% CI 55.7–61.6) at 12 and 24 months respectively (p < 0.05). Mean VAS score improved from 63 (95% CI 56.0–68.1) preoperatively to 32 (95% CI 24.4–38.3) at 24 months. The improvement exceeded the minimal clinically important difference (MCID) and this improvement was maintained over time. Location of defect and history of previous cartilage repair did not significantly affect the outcome (p > 0.05). CONCLUSION: The study suggests that at 2 years, Episealer® implants are safe with a low failure rate of 2.5% and result in clinically significant improvement. Individualised mini-metal implants with appropriate accurate guides for implantation appear to have a place in the management of focal femoral chondral and osteochondral defects in the knee. LEVEL OF EVIDENCE: IV. Springer Berlin Heidelberg 2020-10-06 2021 /pmc/articles/PMC8384793/ /pubmed/33025052 http://dx.doi.org/10.1007/s00167-020-06289-7 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Knee
Holz, Johannes
Spalding, Tim
Boutefnouchet, Tarek
Emans, Pieter
Eriksson, Karl
Brittberg, Mats
Konradsen, Lars
Kösters, Clemens
Verdonk, Peter
Högström, Magnus
Lind, Martin
Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years
title Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years
title_full Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years
title_fullStr Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years
title_full_unstemmed Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years
title_short Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years
title_sort patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years
topic Knee
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384793/
https://www.ncbi.nlm.nih.gov/pubmed/33025052
http://dx.doi.org/10.1007/s00167-020-06289-7
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