Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress of degenerative processes. However, restoration of the articular cartilage cannot be accomplished. If the conservative treatment fails unicompartmental arthroplasty, patellofemoral joint replacement or focal resurfacing are reasonable options to postpone total knee arthroplasty. A careful patient selection before surgery is crucial for all three treatment options. The following overview reports indications and outcomes of medial partial knee replacement, patellofemoral partial knee replacement, and focal resurfacing treatment options for focal chondral defects.

The effect of radiofrequency chondroplasty on cartilage tissue is not well studied. This prospective pilot study investigates the effect of radiofrequency chondroplasty on International Cartilage Repair Society (ICRS) grade II patellar cartilage defects using high-resolution magnetic resonance imaging (MRI) with T2 mapping. Six consecutive patients were treated for ICRS grade II patellar cartilage defects using radiofrequency chondroplasty. Before surgery and at defined follow-ups (2 weeks, 4 and 12 months) a high-resolution morphological 3 Tesla MRI with quantitative T2 mapping was performed. At baseline MRI, global T2 values of cartilage defects were increased (46.8 ms ± 9.7) compared to healthy cartilage (35.2 ms ± 4.5) in the same knee which served as reference. Two weeks after treatment, global T2 values (39.2 ms ± 7.7) of the defect areas decreased. However, global T2 values of the defect areas increased beyond the preoperative levels at 4 months (47.4 ms ± 3.1) and 12 months (51.5 ms ± 5.9), respectively. Zonal T2 mapping revealed that the predominant changes in T2 values occurred at the superficial cartilage layer. T2 mapping appears to be an ideal method to monitor cartilage degeneration after chondroplasty. Based on the small sample size of this pilot study, radiofrequency chondroplasty may cause cartilage damage and may not have a long-lasting effect in the treatment of grade II patellar cartilage defects. In five out of six patients, postoperative cartilage damage was observed on quantitative MRI. This study was therefore terminated before completion. We recommend only addressing the pathology which indicated arthroscopy and leaving concomitant cartilage lesions untreated.

Background/Objectives: Cancer is the second leading cause of death, and spinal metastases may occur in up to 40% of patients with cancer. The purpose of the current study is to evaluate survival after surgical treatment of spinal metastases, and to identify risk factors that might shorten postoperative survival. Methods: Two-hundred sixty-eight patients who underwent surgery due to spinal metastases at a single center between 1990 and 2019 were evaluated retrospectively. Various variables and prognostic scores were analyzed to assess their impact on postoperative survival. Results: Two-hundred thirty-three patients (86.9%) died with a mean time from surgery to death of 14.84 months. Twelve months postoperatively, the survival rate of the entire cohort was 41.8%. Patients who were 65 years or older and were bedbound or in a wheelchair had a significantly shorter survival rate (p = 0.007). Further risk factors for a worse survival rate were: higher preoperative ASA-score (β = 2.19, 95% CI 1.34–3.57; p = 0.002), higher age at the time of surgery (β = 1.03, 95% CI 1.00–1.05; p = 0.041), presence of preoperative additional extraspinal bone metastases (β = 1.15, 95% CI 1.01–3.76; p = 0.047), ambulatory status (β = 1.21, 95% CI 1.04–1.4; p = 0.013), and elevated CRP-value > 5 mg/dL (β = 3.02, 95% CI 1.59–5.73; p = 0.001). Conclusions: Patients who are 65 years or older and bedbound or in a wheelchair had a significantly shorter survival period. When considering treatment options for patients with spinal metastases, a higher ASA-score, a higher age at the time of surgery, the presence of preoperative additional extraspinal bone metastases, being bedbound or in a wheelchair, and an elevated CRP-value > 5 mg/dL should be considered as significant risk factors for a worse survival rate. Available prognostic scores may only predict a patient’s survival accurately in the short-term follow-up.

Background/Objectives: The aim of this study was the investigation of any correlation between medial meniscal extrusion (MME) and T2 relaxation times. Furthermore, the impact of different meniscal morphologies on the femoral cartilage was assessed. Methods: Fifty-nine knees of fifty-five patients (twenty-four female, thirty-one male) with a mean age of 33.7 ± 9.2 years and without risk factors for MME or osteoarthritis were examined in a 3.0T MRI. MME was assessed quantitatively in accordance with BLOKS score. T2 maps were calculated from sagittal 2D MESE sequences. The region of interest was defined as the load-bearing cartilage at the medial femoral condyle and analysis was performed on two consecutive slices. T2 values were correlated to MME; furthermore, mean T2 values were compared in different grades of MME. Results: T2 values showed a strong correlation with increasing MME (r = 0.635; p < 0.001) in an exponential pattern. Analogously, knees with MME ≥ 3 mm showed statistically significant higher T2 values (p < 0.001) compared to knees with MME ≤ 2 mm and 2.1–2.9 mm; between the latter two, no differences in T2 values were found. Conclusions: T2 values showed a strong correlation with increasing MME. Consequently, MME ≥ 3 mm has a detectable impact on the cartilage of the femur.