Modified advanced core decompression (mACD)

Operative Orthopädie und Traumatologie
Stefan Landgraeber, Marcus Jäger

Abstract

The modified advanced core decompression (mACD) combines the advantages of a low invasive core decompression with maximal removal of osteonecrotic bone and a biologic reconstruction of the resulting bone defect. Avascular (atraumatic) osteonecrosis of the femoral head (ARCO stage II). Subchondral fractures (ARCO stage III); advanced osteoarthritis (e.g., ACRO stage IV); persisting risk factors such as high-dose corticoid therapy, chemotherapy, alcohol abuse; open growth plates; history of side effects or intolerance to components of the applied bone substitute; lack of patient compliance; osteomyelitis or other septic conditions. Supine positioning on the operation table, skin disinfection, and sterile draping. Skin incision and core decompression using a 3.2 mm guide wire. Removal of a bone cylinder from a nonaffected area of the femoral neck using a hollow trephine. Drilling of the osteonecrotic area over the applied wire up to 5 mm to the subchondral bone under fluoroscopy, insertion of an expandable bone knife and removal of the osteonecrotic bone supported by a curette. Bone grafting of the autologous bone into the subchondral defect zone and filling of the drill canal by resorbable bone substitute. Bed rest for 24 h, then...Continue Reading

References

May 28, 1992·The New England Journal of Medicine·H J Mankin
Mar 1, 1995·The Journal of Bone and Joint Surgery. American Volume·M A Mont, D S Hungerford
Mar 1, 1996·Clinical Orthopaedics and Related Research·M A MontA C Fairbank
Feb 2, 1999·The Journal of Arthroplasty·C J OrtigueraM E Cabanela
Mar 21, 2008·Clinical Orthopaedics and Related Research·Thorsten M SeylerMichael A Mont
Apr 9, 2008·Clinical Orthopaedics and Related Research·David R MarkerMichael A Mont
Apr 11, 2012·Journal of Tissue Engineering and Regenerative Medicine·Stefan LandgraeberWojciech Kowalczyk
Dec 28, 2012·Polish journal of radiology·Agata Małkiewicz, Magdalena Dziedzic
Apr 9, 2013·Clinical Orthopaedics and Related Research·Muyibat A AdelaniJohn C Clohisy
Jul 17, 2015·Journal of Tissue Engineering and Regenerative Medicine·Tim ClassenStefan Landgraeber
Jul 18, 2015·Archives of Orthopaedic and Trauma Surgery·Stefan LandgraeberWojciech Kowalczyk
Dec 17, 2015·Archives of Orthopaedic and Trauma Surgery·A RothS J Breusch
Nov 23, 2017·BMC Musculoskeletal Disorders·Stefan LandgraeberMarcus Jäger
Aug 18, 2018·Der Orthopäde·Andreas RothMarkus Tingart

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Citations

May 6, 2021·Journal of Hip Preservation Surgery·Sebastian SerongStefan Landgraeber
Sep 10, 2021·Der Orthopäde·Marcus Jäger

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