Autologous osteochondral transplantation for the treatment of chondral defects of the knee
Introduction
The management of full-thickness chondral defects of a weight-bearing articular surface remains a contentious issue. The repair capacity of articular cartilage is limited, especially in large defects occurring after skeletal maturity [1], [2], [3], [4], [5]. Spontaneous repair as well as resurfacing promoted by treatment options such as abrasion arthroplasty, microfractures and drilling occurs with the formation of reparative fibrocartilage, has poor biomechanical characteristics compared to hyaline cartilage [2], [5].
Osteochondral autograft transplantation is a method, which provides autologous hyaline cartilage for resurfacing the chondral defect, thus reconstructing more accurately both the histological and biomechanical properties of the articular surface [6], [7], [8], [9], [10], [11]. It has, though, technical limitations, mainly related to the size of the defect and to donor site morbidity [12].
Our aim was to evaluate the mid- and long-term functional outcome of the treatment of osteochondral defects of the knee joint with autologous osteochondral transplantation with the OATS technique.
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Materials and methods
Between July 1998 and March 2003, 42 patients underwent 43 procedures for autologous osteochondral transplantation (one bilateral) with the OATS technique (Osteochondral Autograft Transplantation System, Arthrex, Naples, USA). Six patients were not available on final follow-up, and therefore, 36 patients (37 procedures) were included in this study. Of those patients, 23 were male and 13 were female with a mean age of 31.9 years (range: 18–48 years). The cause of the chondral defect was
Results
The average area of the osteochondral lesion covered with autologous osteochondral transplantation ranged from 0.8 to 12 cm2 (average: 2.73 cm2). The diameter of the grafts used ranged from 6 to 10 mm and 1 to 8 grafts were used in each case to achieve > 90% covering of the lesion area. Patients were hospitalised for an average period of 3.06 days (range 1–6 days).
Patients were followed for a minimum of 18 months (average: 36.9 months, range: 18–73 months). The average score in their Tegner
Discussion
Osteochondral defects spontaneously heal with fibrocartilage and treatment options such as abrasion arthroplasty, microfractures and drilling also promote the formation of fibrocartilaginous tissue, whose load-bearing properties and histological characteristics are significantly inferior to those of normal hyaline cartilage [2], [14], [15], [16]. Furthermore, fibrocartilage has been shown to fibrillate and degrade with time, resulting in further deterioration of its loading characteristics [17]
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