Imre Szerb

Bio: Imre Szerb is an academic researcher. The author has contributed to research in topics: Osteoarthritis & Synovitis. The author has an hindex of 5, co-authored 10 publications receiving 761 citations.

Mosaicplasty for the Treatment of Osteochondritis Dissecans of the Talus: Two to Seven Year Results in 36 Patients

Abstract: An osteochondral defect (OCD) is known as a symptomatic lesion causing pain, recurrent synovitis, and altered joint mechanics most commonly in a weightbearing joint. Loose bodies may develop, which...

Treatment of Osteochondritis Dissecans of the Talus: Use of the Mosaicplasty Technique—A Preliminary Report

Abstract: A one-stage autogenous osteochondral grafting technique for the treatment of talar dome osteochondritis dissecans is described. Eleven patients with osteochondritis dissecans lesions, 10 mm or greater in diameter, were operated on using the mosaicplasty autogenous osteochondral transplantation technique. Osteochondral cylindrical grafts from the ipsilateral knee were delivered into the talar defect using specially designed tube chisels. These procedures were done by arthrotomy. With follow-up of 12 to 28 months (mean, 16 months), the patients returned to full activities and the results, using the Hannover scoring system, have been excellent.

Current Concepts: Treatment of Osteochondral Ankle Defects

Abstract: Osteochondral ankle defects cause various symptoms including pain, swelling, and limited range of motion. When surgical treatment is necessary, several treatment options exist. Arthroscopic debridement and drilling, arthroscopic autologous osteochondral transplantation (mosaiclasty), and autologous chondrocyte transplantation are discussed more extensively. Treatment results of each technique are discussed, and a guideline for treatment is presented.

Mosaicplasty: Long-term follow-up

Abstract: The successful treatment of chondral and osteochondral defects of the weightbearing surfaces is a challenge for orthopaedic surgeons. Autologous osteochondral transplantation is one method that can be used to create a hyaline or hyaline-like repair in the defect area. Ten years of clinical experience with autologous osteochondral mosaicplasty are described. Clinical scores, imaging techniques, arthroscopy, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage in a total of 831 patients who underwent mosaicplasty. According to our investigations, good-to-excellent results were achieved in 92% of the patients treated with femoral condylar implantations, in 87% of those treated with tibial resurfacing, in 79% of those treated with patellar and/or trochlear mosaicplasties, and in 94% of those treated with talarprocedures. Long-term donor-site disturbances, which were assessed using the Bandi score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of 83 patients who were followed arthroscopically showed congruent gliding surfaces, histological evidence of the survival of the transplanted hyaline cartilage, and fibrocartilage filling of the donor sites. Four deep infections and 36 painful postoperative hemarthroses were experienced as complications arising from the surgical procedures. On the basis of both these promising results and also those of other similar studies, autologous osteochondral mosaicplasty would appears to be an alternative for the treatment of small and medium-sized focal chondral and osteochondral defects of the weightbearing surfaces of the knee and other weightbearing synovial joints.

Effectiveness evaluation of radiosynovectomy on the radiological progression of osteoarthritis of the knee joint.

Abstract: OBJECTIVES This study aims to analyze the effect of radiosynovectomy (RSO) on the radiological progression of osteoarthritis of the knee joint. PATIENTS AND METHODS The study included 207 knee joints of 181 patients (72 males, 109 females; mean age 58 years; range, 19 to 65 years) that were performed RSO between 01 April 2003 and 31 December 2015 in the Department of Orthopedics and Traumatology at Uzsoki Hospital. A total of 111 right and 96 left knees were treated. The mean duration of follow-up was 8.7 years (range, 1 to 12 years). Of the 181 patients, both knee joints were treated in 26. RESULTS Of the 207 treated knee joints, 163 had the same Kellgren-Lawrence grade at the time of follow-up compared to the grade at the time of RSO, while 44 had worse outcomes. This indicated that radiological progression was not present in 79% of the treated knee joints. The intraclass correlation coefficient (ICC) showed significantly strong agreement between the pre- and post-measurements (ICC=0.835, p<0.001). CONCLUSION Radiosynovectomy was able to impede radiological progression in 79% of the treated joints and only one-grade deterioration was observed in 39 cases during follow-up.

Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience.

Abstract: Background: The successful treatment of chondral and osteochondral defects of the weight-bearing surfaces is a challenge for orthopaedic surgeons. Autologous osteochondral transplantation is one method that can be used to create hyaline or hyaline-like repair in the defect area. This paper describes the results after ten years of clinical experience with autologous osteochondral mosaicplasty. Methods: Clinical scores, imaging techniques, arthroscopy, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage in 831 patients undergoing mosaicplasty. Results: According to these investigations, good-to-excellent results were achieved in 92% of the patients treated with femoral condylar implantations, 87% of those treated with tibial resurfacing, 79% of those treated with patellar and/or trochlear mosaicplasties, and 94% of those treated with talar procedures. Long-term donor-site disturbances, assessed with use of the Bandi score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of eighty-three patients who were followed arthroscopically showed congruent gliding surfaces, histological evidence of the survival of the transplanted hyaline cartilage, and fibrocartilage filling of the donor sites. Complications of the surgery included four deep infections and thirty-six painful postoperative hemarthroses. Conclusions: On the basis of these promising results and those of other similar studies, autologous osteochondral mosaicplasty appears to be an alternative for the treatment of small and medium-sized focal chondral and osteochondral defects of the weight-bearing surfaces of the knee and other weight-bearing synovial joints.

Current Concepts Review - The Healing and Regeneration of Articular Cartilage*

Abstract: It is well established that damaged articular cartilage has a very limited potential for healing, and articular defects larger than two to four millimeters in diameter rarely heal even with such advances as the use of continuous passive motion26,36,70,98,101,128,130,138,162,163,208. Damage to articular cartilage is a common problem: in one study, it was associated with 16 percent (twenty-one) of 132 injuries of the knee that were sufficient to cause intra-articular bleeding88. Furthermore, damage to a joint surface can lead to premature arthritis128. Twyman et al. prospectively followed twenty-two knees in which osteochondritis dissecans had been diagnosed before skeletal maturity; at an average of thirty-four years, 32 percent had radiographic evidence of moderate or severe osteoarthritis235. Only 50 percent had a good or excellent functional result. Elderly patients (those who are sixty-five years of age or older) who have an arthritic condition can obtain dramatic relief from pain and restoration of function after total joint replacement. However, such procedures have higher rates of failure in young and early-middle-aged patients (those who are less than forty years old and those who are forty to sixty years old, respectively) than in elderly patients194. This leaves a large group of patients spanning a broad age-group, many of whom are in their prime, for whom there is no currently acceptable and reliable treatment. A typical example is that of a young, healthy individual who has arthrosis or osteochondritis dissecans following an injury to a joint. It might be possible to solve this patient's problems if the lost or damaged segment of articular cartilage inside the involved joint could be regenerated. After it had been restored, the …

Articular cartilage injuries.

Abstract: The acute and repetitive impact and torsional joint loading that occurs during participation in sports can damage articular surfaces causing pain, joint dysfunction, and effusions. In some instances, this articular surface damage leads to progressive joint degeneration. Three classes of chondral and osteochondral injuries can be identified based on the type of tissue damage and the repair response: (1) damage to the joint surface that does not cause visible mechanical disruption of the articular surface, but does cause chondral damage and may cause subchondral bone injury; (2) mechanical disruption of the articular surface limited to articular cartilage; and (3) mechanical disruption of articular cartilage and subchondral bone. In most instances, joints can repair damage that does not disrupt the articular surface if they are protected from additional injury. Mechanical disruption of articular cartilage stimulates chondrocyte synthetic activity, but it rarely results in repair of the injury. Disruption of subchondral bone stimulates chondral and bony repair, but it rarely restores an articular surface that duplicates the biologic and mechanical properties of normal articular cartilage. In selected patients, surgeons have used operative treatments including penetrating subchondral bone, soft tissue grafts, and cell transplants and osteochondral autografts and allografts to restore articular surfaces after chondral injuries. Experimental studies indicate that use of artificial matrices and growth factors also may promote formation of a new joint surface. However, an operative treatment of an articular surface injury that will benefit patients must not just provide a new joint surface, it must produce better long-term joint function than would be expected if the injury was left untreated or treated by irrigation and debridement alone. Therefore, before selecting a treatment for a patient with an articular cartilage injury, the surgeon should define the type of injury and understand its likely natural history.

Treatment of osteochondral lesions of the talus: a systematic review

Abstract: The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from January 1966 to December 2006 were systematically screened. The proportion of the patient population treated successfully was noted, and percentages were calculated. For each treatment strategy, study size weighted success rates were calculated. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. One randomized clinical trial was identified. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Retrograde drilling and fixation scored 88 and 89%, respectively. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus.