The aim of this work is to investigate the capability of PRP as an adjuvant therapy to autologous chondrocyte implantation (ACI) in combination with multi-axial load with respect to cartilage regeneration. Articular cartilage shows poor repair capacity and therapies for cartilage defects are still lacking. Well-established operative treatments include ACI, and growing evidence shows the beneficial effects of PRP. Platelets contain numerous growth factors, among them transforming growth factor beta (TGF-β). Dynamic mechanical loading is known to be essential for tissue formation, improving extracellular matrix (ECM) production. For our ACI model monolayer expanded human chondrocytes were seeded into polyurethane scaffolds and embedded in fibrin (hChondro), in PRP-Gel (PRP), or in fibrin with platelet lysate (PL), which was added to the media once a week with a concentration of 50 vol%. The groups were either exposed to static conditions or multi-axial forces in a ball-joint bioreactor for 1 h per day over 2 weeks, mimicking ACI under physiological load. The culture medium was collected and analyzed for glycosaminoglycan (GAG), nitrite and transforming growth factor beta 1 (TGF-β1) content. The cell-scaffold constructs were collected for DNA and GAG quantification; the expression of chondrogenic genes, TGF-β and related receptors, as well as inflammatory genes, were analyzed using qPCR. Loading conditions showed superior chondrogenic differentiation (upregulation of COL2A1, ACAN, COMP and PRG4 expression) than static conditions. PRP and PL groups combined with mechanical loading showed upregulation of COL2A1, ACAN and COMP. The highest amount of total TGF-β1 was quantified in the PL group. Latent TGF-β1 was activated in all loaded groups, while the highest amount was found in the PL group. Load increased TGFBR1/TGFBR2 mRNA ratio, with further increases in response to supplements. In general, loading increased nitrite release into the media. However, over time, the media nitrite content was lower in the PL group compared to the control group. Based on these experiments, we conclude that chondrogenic differentiation is strongest when simulated ACI is performed in combination with dynamic mechanical loading and PRP-gel or PL supplementation. An inflammatory reaction was reduced by PRP and PL, which could be one of the major therapeutic effects. Loading presumably can enhance the action of TGF-β1, which was predominantly activated in loaded PL groups. The combination of load and PRP represents an effective and promising synergy concerning chondrocyte-based cartilage repair.

Symptomatic intervertebral disc (IVD) degeneration accounts for significant socioeconomic burden. Recently, the expression of the tissue renin-angiotensin system (tRAS) in rat and bovine IVD was demonstrated. The major effector of tRAS is angiotensin II (AngII), which participates in proinflammatory pathways. The present study investigated the expression of tRAS in human IVDs, and the correlation between tRAS, inflammation and IVD degeneration. Human IVD tissue was collected during spine surgery and distributed according to principal diagnosis. Gene expression of tRAS components, proinflammatory and catabolic markers in the IVD tissue was assessed. Hydroxyproline (OHP) and glycosaminoglycan (GAG) content in the IVD tissue were determined. Tissue distribution of tRAS components was investigated by immunohistochemistry. Gene expression of tRAS components such as angiotensin-converting enzyme (ACE), Ang II receptor type 2 (AGTR2), angiotensinogen (AGT) and cathepsin D (CTSD) was confirmed in human IVDs. IVD samples that expressed tRAS components (n = 21) revealed significantly higher expression levels of interleukin 6 (IL-6), tumour necrosis factor α (TNF-α), a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 4 and 5 compared to tRAS-negative samples (n = 37). Within tRAS-positive samples, AGT, matrix-metalloproteinases 13 and 3, IL-1, IL-6 and IL-8 were more highly expressed in traumatic compared to degenerated IVDs. Total GAG/DNA content of non-tRAS expressing IVD tissue was significantly higher compared to tRAS positive tissue. Immunohistochemistry confirmed the presence of AngII in the human IVD. The present study identified the existence of tRAS in the human IVD and suggested a correlation between tRAS expression, inflammation and ultimately IVD degeneration.

Discogenic low back pain (LBP) is a main cause of disability and inflammation is presumed to be a major driver of symptomatic intervertebral disc degeneration (IDD). Anti-inflammatory agents are currently under investigation as they demonstrated to alleviate symptoms in patients having IDD. However, their underlying anti-inflammatory and regenerative activity is poorly explored. The present study sought to investigate the potential of Etanercept and Tofacitinib for maintaining disc homeostasis in a preclinical intervertebral disc (IVD) organ culture model within IVD bioreactors allowing for dynamic loading and nutrient exchange. Bovine caudal IVDs were cultured in a bioreactor system for 4 days to simulate physiological or degenerative conditions: (1) Phy-physiological loading (0.02-0.2 MPa; 0.2 Hz; 2 h/day) and high glucose DMEM medium (4.5 g/L); (2) Deg+Tumor necrosis factor α (TNF-α)-degenerative loading (0.32-0.5 MPa; 5 Hz; 2 h/day) and low glucose DMEM medium (2 g/L), with TNF-α injection. Etanercept was injected intradiscally while Tofacitinib was supplemented into the culture medium. Gene expression in the IVD tissue was measured by RT-qPCR. Release of nitric oxide (NO), interleukin 8 (IL-8) and glycosaminoglycan (GAG) into the IVD conditioned medium were analyzed. Cell viability in the IVD was assessed using lactate dehydrogenase and ethidium homodimer-1 staining. Immunohistochemistry was performed to assess protein expression of IL-1β, IL-6, IL-8, and collagen type II in the IVD tissue. Etanercept and Tofacitinib downregulated the expression of IL-1β, IL-6, IL-8, Matrix metalloproteinase 1 (MMP1), and MMP3 in the nucleus pulposus (NP) tissue and IL-1β, MMP3, Cyclooxygenase-2 (COX2), and Nerve growth factor (NGF) in the annulus fibrosus (AF) tissue. Furthermore, Etanercept significantly reduced the IL-1β positively stained cells in the outer AF and NP regions. Tofacitinib significantly reduced IL-1β and IL-8 positively stained cells in the inner AF region. Both, Etanercept and Tofacitinib reduced the GAG loss to the level under physiological culture condition. Etanercept and Tofacitinib are able to neutralize the proinflammatory and catabolic environment in the IDD organ culture model. However, combined anti-inflammatory and anabolic treatment may be required to constrain accelerated IDD and relieving inflammation-induced back pain.

The use of human mesenchymal stromal cells (hMSCs) for cartilage regeneration has been hampered by the inherent donor variation of primary monolayer expanded cells. Although CD markers are typically used to characterize cell populations, there is no correlation between CD marker profile and functional outcomes. Therefore, we aimed to discover novel predictive MSC chondrogenesis markers. The chondrogenic potential of primary human bone marrow MSCs (hBMSCs) over multiple passages was assessed by standard pellet culture. We confirmed that the ratio of TGFβ-RI/TGFβ-RII at the time of cell recovery from the tissue culture plastic reliably predicted chondrogenic potential. Furthermore, it is possible to prospectively characterize any human BMSC cell population as responders or non-responders with respect to chondrogenic differentiation potential. Transient increase of the ratio with siRNA knockdown of TGFβ-RII reproducibly recovered the chondrogenic differentiation ability of non-responsive MSCs. Together this offers an opportunity to produce a more functionally characterized cell population for use in autologous cartilage repair therapies.

Background Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the chest and concomitant immobilization due to spinal instability, pain or neurological dysfunction, impairing the respiratory system individually and together. Thus, we proposed that an early stabilization of thoracolumbar spine fractures will result in significant benefits regarding respiratory organ function, multiple organ failure and length of ICU / hospital stay. Methods Patients documented in the TraumaRegister DGU®, aged ≥16 years, ISS ≥ 16, AIS Thorax ≥ 3 with a concomitant thoracic and / or lumbar spine injury severity (AIS Spine ) ≥ 3 were analyzed. Penetrating injuries and severe injuries to head, abdomen or extremities (AIS ≥ 3) led to patient exclusion. Groups with fractures of the lumbar (LS) or thoracic spine (TS) were formed according to the severity of spinal trauma (AIS spine ): AIS LS = 3, AIS LS = 4–5, AIS TS = 3 and AIS TS = 4–5, respectively. Results 1740 patients remained for analysis, with 1338 (76.9%) undergoing spinal surgery within their hospital stay. 976 (72.9%) had spine surgery within the first 72 h, 362 (27.1%) later on. Patients with injuries to the thoracic spine (AIS TS = 3) or lumbar spine (AIS LS = 3) significantly benefit from early surgical intervention concerning ventilation time (AIS LS = 3 only), ARDS, multiple organ failure, sepsis rate (AIS TS = 3 only), length of stay in the intensive care unit and length of hospital stay. In multiple injured patients with at least severe thoracic spine trauma (AIS TS ≥ 4) early surgery showed a significantly shorter ventilation time, decreased sepsis rate as well as shorter time spend in the ICU and in hospital. Conclusions Multiply injured patients with at least serious thoracic trauma (AIS Thorax ≥ 3) and accompanying spine trauma can significantly benefit from early spine stabilization within the first 72 h after hospital admission. Based on the presented data, primary spine surgery within 72 h for fracture stabilization in multiply injured patients with leading thoracic trauma, especially in patients suffering from fractures of the thoracic spine, seems to be beneficial.

Background: Articular cartilage defects often result in pain, loss of function and finally osteoarthritis. Developing cell-based therapies for cartilage repair is a major goal of orthopaedic research. Autologous chondrocyte implantation is currently the gold standard cell-based surgical procedure for the treatment of large, isolated, full thickness cartilage defects. Several disadvantages such as the need for two surgical procedures or hypertrophic regenerative cartilage, underline the need for alternative cell sources. Objective: Mesenchymal stem cells, particularly synovium-derived mesenchymal stem cells, represent a promising cell source. Synovium-derived mesenchymal stem cells have attracted considerable attention since they display great chondrogenic potential and less hypertrophic differentiation than mesenchymal stem cells derived from bone marrow. The aim of this review was to summarize the current knowledge on the chondrogenic potential for synovial stem cells in regard to cartilage repair purposes. Results: A literature search was carried out identifying 260 articles in the databases up to January 2017. Several in vitro and initial animal in vivo studies of cartilage repair using synovia stem cell application showed encouraging results. Since synvoium-derived stem cells are located in the direct vicinity of cartilage and cartilage lesions these cells might even contribute to natural cartilage regeneration. The only one published human in vivo study with 10 patients revealed good results concerning postoperative outcome, MRI, and histologic features after a two-stage implantation of synovial stem cells into an isolated cartilage defect of the femoral condyle. Conclusion: Synovium-derived stem cells possess great chondrogenic potential and showed encouraging results for cartilage repair purposes. Furthermore, synovial stem cells play an important role in joint homeostasis and possibly in natural cartilage repair. Further studies are needed to elucidate the interplay of synovial stem cells and chondrocytes, and the promising role of synovium-derived stem cells in cartilage tissue engineering.

Introduction Lumbar spinal stenosis (LSS) is a kinetic-dependent disease typically aggravating during spinal loading. To date, assessment of LSS is usually performed with magnetic resonance imaging (MRI). However, conventional supine MRI is associated with significant drawbacks as it does not truly reflect physiological loads, experienced by discoligamentous structures during erect posture. Consequently, supine MRI often fails to reveal the source of pain and/or disability caused by LSS. The present study sought to assess neural dimensions via MRI in supine, upright, and upright-hyperlordotic position in order to evaluate the impact of patient positioning on neural narrowing. Therefore, radiological measures such as neuroforaminal dimensions, central canal volume, sagittal listhesis, and lumbar lordosis at spinal level L4/5 were extracted and stratified according to patient posture. Materials and methods Overall, 10 subjects were enclosed in this experimental study. MRI was performed in three different positions: (1) 0° supine (SP), (2) 80° upright (UP), and (3) 80° upright + hyperlordotic (HY) posture. Upright MRI was conducted utilizing a 0.25T open-configuration scanner equipped with a rotatable examination bed allowing for true standing MRI. Radiographic outcome of upright MRI imaging was extracted and evaluated according to patient positioning. Results Upright MRI-based assessment of neural dimensions was successfully accomplished in all subjects. Overall, radiographic parameters revealed a significant decrease of neural dimensions from supine to upright position: Specifically, mean foraminal area decreased from SP to UP by 13.3% (P ≤ 0.05) as well as from SP to HY position by 21% (P ≤ 0.05). Supplementation of hyperlordosis did not result in additional narrowing of neural elements (P ≥ 0.05). Furthermore, central canal volume revealed a decrease of 7% at HY and 8% at UP compared to SP position (P ≥ 0.05). Assessment of lumbar lordosis yielded in a significant increase when assessed at HY (+22.1%) or UP (+8.7%) compared to SP (P ≤ 0.05). Conclusions Our data suggest that neuroforaminal dimensions assessed by conventional supine MRI are potentially overestimated in patients with LSS. Especially, in patients having occult disease not visualized on conventional imaging modalities, upright MRI allows for a precise, clinically relevant, and at the same time non-invasive evaluation of neural elements in LSS when neural decompression is considered.

The aim of this study was to compare the effect of different disease initiators of degenerative disc disease (DDD) within an intervertebral disc (IVD) organ culture system and to understand the interplay between inflammation and degeneration in the early stage of DDD. Bovine caudal IVDs were cultured within a bioreactor for up to 11 days. Control group was cultured under physiological loading (0.02-0.2 MPa; 0.2 Hz; 2 hr/day) and high glucose (4.5 g/L) medium. Detrimental loading (0.32-0.5 MPa, 5 Hz; 2 hr/day) and low glucose (2 g/L) medium were applied to mimic the condition of abnormal mechanical stress and limited nutrition supply. Tumour necrosis factor alpha (TNF-α) was injected into the nucleus pulposus (100 ng per IVD) as a proinflammatory trigger. TNF-α combined with detrimental loading and low glucose medium up-regulated interleukin 1β (IL-1β), IL-6, and IL-8 gene expression in disc tissue, nitric oxide, and IL-8 release from IVD, which indicate a proinflammatory effect. The combined initiators up-regulated matrix metalloproteinase 1 gene expression, down-regulated gene expression of Type I collagen in annulus fibrosus and Type II collagen in nucleus pulposus, and reduced the cell viability. Furthermore, the combined initiators induced a degradative effect, as indicated by markedly higher glycosaminoglycan release into conditioned medium. The combination of detrimental dynamic loading, nutrient deficiency, and TNF-α intradiscal injection can synergistically simulate the proinflammatory and degenerative disease condition within DDD. This model will be of high interest to screen therapeutic agents in further preclinical studies for early intervention and treatment of DDD.

BACKGROUND:Musculoskeletal complaints are frequently diagnosed in Paralympic athletes. Despite the increased professionalism in Paralympic Sports, the documentation of injuries and other health complaints during high-level competition is sparse. With respect to the upcoming Paralympic Summer Games in Rio de Janeiro, the aim of this study was the analysis of all musculoskeletal complaints within the German Paralympic Athletes during the London 2012 Paralympic Games.METHODS:All musculoskeletal complaints (MSC) of the 150 German athletes seeking medical attention, hereby defined as "injury", were recorded during the in-competition period of the London Paralympics Games (22 days), regardless of their severity and consequences. Standardized documentation included the onset of symptoms, the medical diagnoses, the therapeutic measures taken as well as consecutive restrictions in training and competition. Incidence rates and localizations were analyzed by sports discipline.RESULTS:A total of 201 musculoskeletal complaints were recorded for 140 athletes (93.3%), corresponding to 1.4 musculoskeletal complaints per "injured" athlete. The incidence of musculoskeletal complaints in German athletes was 62.9±15.4/1000 athlete-days. High incidence rates (IR) were observed in wheelchair basketball (IR 72/1000 athlete-days, 1.6 injuries per athlete) and equestrian events (IR 72.7, 1.6). Musculoskeletal complaints were mainly located in the upper extremities (37.6%) and the spine (37.6%). The most frequent diagnoses were myalgia (N.=105, 52%).CONCLUSIONS:We noted a high rate of musculoskeletal complaints among German Paralympic athletes across sports and body parts, highlighting the need for prevention programs that focus on the upper extremities and spine.

Zusammenfassung Hintergrund Die Bedeutung eines standardisierten Monitoring Systems von Erkrankungen und Verletzungen bei Leistungssportlern wurde in den letzten Jahren vielfach betont. Trotz der zunehmenden Trainings- und Wettkampfbelastung von paralympischen Athleten stellt das kontinuierliche Gesundheits-Monitoring im Behindertensport eine Raritat dar. Das Ziel der vorliegenden Studie war die Prufung der Machbarkeit und Auswertung eines Injury und Illness Surveillance Systems (IISS) in der deutschen Paracycling Nationalmannschaft wahrend der Vorbereitungsphase auf die paralympischen Spiele in Rio de Janeiro 2016. Material und Methoden Uber einen Zeitraum von 24 Wochen wurde mittels eines validierten Online-Fragebogens wochentlich der Gesundheitsstatus des deutschen Paracycling Nationalkaders von Oktober 2015 bis Marz 2016 erfasst. Der Oslo Sports Trauma Research Centre (OSTRC) Fragebogen hat sich als valide und reliabel im Monitoring von akuten Verletzungen und Erkrankungen sowie Uberlastungsbeschwerden gezeigt. Das Auftreten von Verletzungen und Erkrankungen, Trainingsausfallzeiten, die Einschrankung der Leistungsfahigkeit sowie der aktuelle Trainingsumfang wurden erhoben. Ergebnisse 24 der 26 Kaderathleten des paralympischen Radsports wurden nach schriftlicher Einwilligung in die Studie eingeschlossen. Das Durchschnittsalter betrug 36,5 ± 9,7 Jahre. Die Rucklaufquote der Fragebogen betrug 93%. 30 Erkrankungen und 27 Verletzungen wurden wahrend 24 Wochen erfasst. Am haufigsten wurden Verletzungen der Schulter, des Handgelenkes sowie des Kniegelenkes dokumentiert. Die haufigsten Erkrankungen stellten Infekte der oberen Atemwege sowie grippale Infekte im Gesamtkollektiv und Harnwegsinfekte bei querschnittsgelahmten Athleten dar. Insgesamt entstanden im Kollektiv 140 Trainingsausfalltage, davon 27 durch Verletzungen und 111 durch Krankheiten. Das Surveillance-Programm zeigte eine hohe Akzeptanz bei den Athleten. Schlussfolgerungen Ein IISS zur systematischen Erhebung von Verletzungen und Erkrankungen konnte am Kollektiv der deutschen Paracycling Nationalmannschaft bei hoher Zufriedenheit der Sportler und guter Rucklaufquote erfolgreich etabliert werden. Mit der Identifikation von Verletzungsmechanismen und Risikofaktoren behinderter Athleten sollten sportartspezifische Praventionsmasnahmen abgeleitet werden. Evidenzebene Level IV; prospektive Kohortenstudie.

Although minimally invasive posterior spine implant systems have been introduced, clinical studies reported on reduced quality of spinal column realignment due to correction loss. The aim of this study was to compare biomechanically two minimally invasive spine stabilization systems versus the Universal Spine Stabilization system (USS).

In this study we hypothesized that as a simulation of endochondral bone formation, bone marrow stromal cell (BMSC) provide a sequential chondro-osteogenic differentiation potential. A chondrogenic priming of BMSC leads to a spontaneous three-dimensional cell formation. BMSC were chondrogenically differentiated prior to an osteogenic stimulation. Duration of cell culture was 28 days, whereas in group A BMSC were chondrogenically differentiated for 1 day, followed by an osteogenic differentiation for 27 days. In group B BMSC were chondrogenically differentiated for 14 days prior to an osteogenic differentiation of 14 days and group C BMSC were differentiated chondrogenically for 28 days serving as a chondrogenic control group. Chondrogenic priming induced a spontaneous three-dimensional cell formation. To survey the stability of the osteogenic phenotype in the absence of an osteogenic stimulus, investigations were performed in vivo in a specially adapted chorioallantoic membrane model of fertilized White Leghorn eggs. Histology and real time polymerase chain reaction revealed a higher amount of osteogenic extracellular matrix synthesis and significant higher expressions of osteogenic marker genes in group B after 14 days of chondrogenic and 14 days of osteogenic stimulation. Matrix calcification in vivo in the absence of an osteogenic stimulus could be demonstrated. The results of the present study support the theory of a sequential differentiation potential of BMSC. A chondrogenic priming of BMSC stimulated into the osteogenic lineage result in a stable osteogenic phenotype in a scaffold-free, three-dimensional tissue engineering application.

AbstractSpinal canal stenosis is a dynamic phenomenon that becomes apparent during spinal loading. Current diagnostic procedures have considerable short comings in diagnosing the disease to full extend, as they are performed in supine situation. Upright MRI imaging might overcome this diagnostic gap.This study investigated the lumbar neuroforamenal diameter, spinal canal diameter, vertebral body translation, and vertebral body angles in 3 different body positions using upright MRI imaging.Fifteen subjects were enrolled in this study. A dynamic MRI in 3 different body positions (at 0° supine, 80° upright, and 80° upright + hyperlordosis posture) was taken using a 0.25 T open-configuration scanner equipped with a rotatable examination bed allowing a true standing MRI.The mean diameter of the neuroforamen at L5/S1 in 0° position was 8.4 mm on the right and 8.8 mm on the left, in 80° position 7.3 mm on the right and 7.2 mm on the left, and in 80° position with hyperlordosis 6.6 mm (P < 0.05) on the right and 6.1 mm on the left (P < 0.001).The mean area of the neuroforamen at L5/S1 in 0° position was 103.5 mm2 on the right and 105.0 mm2 on the left, in 80° position 92.5 mm2 on the right and 94.8 mm2 on the left, and in 80° position with hyperlordosis 81.9 mm2 on the right and 90.2 mm2 on the left.The mean volume of the spinal canal at the L5/S1 level in 0° position was 9770 mm3, in 80° position 10600 mm3, and in 80° position with hyperlordosis 9414 mm3.The mean intervertebral translation at level L5/S1 was 8.3 mm in 0° position, 9.9 mm in 80° position, and 10.1 mm in the 80° position with hyperlordosis.The lordosis angle at level L5/S1 was 49.4° in 0° position, 55.8° in 80° position, and 64.7 mm in the 80° position with hyperlordosis.Spinal canal stenosis is subject to a dynamic process, that can be displayed in upright MRI imaging. The range of anomalies is clinically relevant and dynamic positioning of the patient during MRI can provide essential diagnostic information which are not attainable with other methods.

Scientific evidence for the treatment of osteochondral lesions (OCLs) of the talus is limited. The aim of this study was an evaluation of the clinical outcome after a one-step autologous subchondral cancellous bone graft and autologous matrix-induced chondrogenesis (AMIC) in medial OCLs of the talus and the assessment of the repair tissue (RT).

Standard procedure for monosegmental anterior spondylodesis often combines anterior stabilization with autologous iliac crest graft. The cross sectional area of the graft to be transplanted should be at least 23.9% of the cross sectional area of the vertebral bodies to be fused. Computed tomography scans (n=348) of polytraumatized patients were obtained in the course of initial diagnosis. The scans were evaluated for vertebral body size and the possible size of autologous bone graft in the region of the anterior superior iliac crest. The evaluation demonstrated that 95% of the quantified iliac crest grafts would achieve the size recommended for anterior spinal fusion between T10 and T12. In 90% of all cases the planned iliac crest graft exceeded the size limit of 23,9% between concerning the endplates T10 and L2. In 85% the planned iliac crest graft exceeded the size limit of 23,9% between T10 and L3. The recommendation to take this value into account for monosegmental anterior spondylodesis should gain in importance in clinical practice.

A common method to restore the sagittal alignment and stabilize the spinal column is a dorso-ventral spondylodesis. It is assumed that correction loss after posttraumatic spondylodesis results from inadequate incorporation of the autologous iliac crest graft. Retrospective documentation of patients with unstable vertebral body fractures of the thoracic or lumbar spine with concomitant rupture of at least one adjacent intervertebral disk who received surgical treatment at our institution from 2000 to 2006. Followed by analysis of the computer tomography documentation of a total of 142 patients with unstable vertebral body fracture stabilized by posterior internal fixator and anterior iliac crest spondylodesis. The following mean angle changes were derived from the second series of CT-scans performed on average 283 days after anterior spondylodesis: vertebral-wedge-angle (VWA): 2.1°; segmental-kyphotic-angle: 4.9°; adjusted-SKA: 4.8°; sagittal index (SI): –0.04; segmental-scoliotic-angle (SSA): 0°; adjusted-SSA: 0°. Changes in VWA, both SKAs and SI postoperatively and prior to ME were statistically significant (P < 0.05). The McAfee fusion assessment of the graft showed: full fusion: cranial 64%, caudal 47%; partial fusion: cranial 20.5%, caudal 29%; lysis: cranial 8.5%, kaudal 17%; graft-resorption: 7%. No correlation was found between the above-mentioned angle changes and fusions grade. The importance of radiological evidence of fusion deficiency is questionable, because the extent of fusion only has a minimal effect on correction loss. Level IV.

Standard procedure for monosegmental anterior spondylodesis often combines anterior stabilization with autologous iliac crest graft. Recent publications defined a minimum size of the graft as a technical specification for this procedure. The cross sectional area of the graft to be transplanted should be at least 23.9% of the cross sectional area of the vertebral bodies to be fused.We investigated whether the required minimum size of autologous graft, as identified both experimentally and clinically, is compatible with the anatomical conditions in central european patients.Computed tomography scans (n = 348) of polytraumatized patients were obtained in the course of initial diagnosis. The scans were evaluated for vertebral body size and the possible size of autologous bone graft in the region of the anterior superior iliac crest. The evaluation of 348 CT scans demonstrated that 95% of the quantified iliac crest grafts would achieve the size recommended for anterior spinal fusion between T10 and T12. In 90% of all cases the planned iliac crest graft exceeded the size limit of 23,9% between concerning the endplates T10 and L2. In 85% the planned iliac crest graft exceeded the size limit of 23,9% between T10 and L3.The recommendation to take this value into account for monosegmental anterior spondylodesis should gain in importance in clinical practice.

Background: There are several reports on long-term clinical outcomes after autologous chondrocyte implantation (ACI) for knee cartilage defect treatment. Few published articles have evaluated defect quality using quantitative magnetic resonance (MR) imaging techniques. Purpose: To evaluate clinical outcomes and the quality of repair tissue (RT) after first-generation periosteum-covered ACI (ACI-P) using qualitative MR outcomes and T2-weighted relaxation times. Study Design: Case series; Level of evidence, 4. Methods: All patients (n = 86) who underwent knee joint ACI-P (from 1997 through 2001) with a postoperative follow-up of at least 10 years were invited for clinical and MR evaluation. Clinical outcomes analysis included pre- and postoperative Lysholm and numeric analog scale (NAS) for pain (10 = worst, 0 = best). Radiographic analysis included postoperative T2-weighted mapping of the RT, RT-associated regions, and healthy control cartilage; MOCART (magnetic resonance observation of cartilage repair tissue) score; a modified Knee Osteoarthritis Scoring System (mKOSS; 0 = best, 15 = worst) score; as well as numeric grading for subjective RT and whole knee joint evaluation (1 = best, 6 = worst). Results: A total of 70 patients (45 male, 25 female; mean age, 33.3 ± 10.2 years; 81% follow-up rate) with 82 defects were available for follow-up at an average 10.9 ± 1.1 years postoperatively, with MR analysis for 59 patients with 71 transplant sites (average defect size, 6.5 ± 4.0 cm2). Final Lysholm (71.0 ± 17.4) and NAS (7.2 ± 1.9) scores improved significantly when compared with preoperative scores (Lysholm: 42.0 ± 22.5; NAS: 2.1 ± 2.1; P < .01 for both). Average transplant T2 was 35.2 ± 11.3 ms and thereby significantly lower ( P = .005) when compared to the intraknee healthy femur T2 (39.7 ± 6.8 ms). The MOCART was 44.9 ± 23.6 and mKOSS was 4.8 ± 3.2. RT subjective grading was 3.3 ± 1.4, while it was 2.3 ± 0.7 for whole joint evaluation. The RT T2 significantly correlated with postoperative NAS ( P = .04; r = −0.28); it also correlated with the healthy femur T2 ( P = .004; r = 0.4). The MOCART significantly correlated with the mKOSS ( P < .001). Conclusion: The MRI outcome is imperfect in this collective of patients. There is only weak correlation of quantitative imaging data and clinical function. Qualitative imaging data are much better correlated to functional outcomes.