Autologous osteochondral transplantation for the treatment of chondral defects of the knee

doi:10.1016/j.knee.2005.05.006

The Knee

Volume 13, Issue 1, January 2006, Pages 32-35

https://doi.org/10.1016/j.knee.2005.05.006 Get rights and content

Abstract

Full-thickness chondral defects of weight-bearing articular surfaces of the knee are a difficult condition to treat. Our aim is to evaluate the mid- and long-term functional outcome of the treatment of osteochondral defects of the knee with autologous osteochondral transplantation with the OATS technique. Thirty-six patients (37 procedures) were included in this study. Twenty-three patients were male and thirteen were female with a mean age of 31.9 years (range: 18–48 years). The cause of the defect was OCD in 10 cases, AVN in 2, lateral patellar maltracking in 7, while in the remaining 17 patients the defect was post-traumatic. The lesion was located on the femoral condyles in 26 cases and the patellofemoral joint in the remaining 11. The average area covered was 2.73 cm² (range: 0.8–12 cm²) and patients were followed for an average of 36.9 months (range: 18–73 months).

The average score in their Tegner Activity Scale was 3.76 (range: 1–8), while their score in Activities of Daily Living Scale of the Knee Outcome Survey ranged from 18 to 98 with an average of 72.3. Thirty-two out of 37 patients (86.5%) reported improvement of their pre-operative symptoms. All but 5 patients returned to their previous occupation while 18 went back to sports. No correlation was found between patient age at operation, the size or site of the chondral lesion and the functional outcome.

We believe that autologous osteochondral grafting with the OATS technique is a safe and successful treatment option for focal osteochondral defects of the knee. It offers a very satisfactory functional outcome and does not compromise the patient's future options.

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.

Section snippets

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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This study is based on a series of 25 patients with a mean age of 28.9 years (range, 16–44 years) who had stage 3 or 4 chondral lesions of the femoral condyles (according to the ICRS or ICRS-OCD scores). The origin of the lesion was osteochondritis dissecans (13 knees), osteochondral fracture sequelae (ten knees), or aseptic osteonecrosis (two knees). The average size of the lesion was 2.11 ± 0.9 cm². Ten patients (40%) had an associated procedure during the osteochondral autograft. The patients were assessed clinically (IKDC and Lysholm-Tegner scores) and radiographically by a reviewer independent of the team of operators.
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Autologous osteochondral transplantation for the treatment of chondral defects of the knee

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Knee

Arthroscopy

Clin Sports Med

Clin Sports Med

Knee

Arthroscopy

Natural progression of osteo-chondral defect in the femoral condyle

Knee

Articular cartilage—To repair or not to repair?

J Bone Joint Surg Br

Osteochondral defects of the knee

Orthopedics

Repair of cartilage defects in the knee

J Knee Surg

Autologous osteochondral grafting in the knee: indication, results and reflections

Clin Orthop

Mosaicplasty for the treatment of articular defects of the knee and ankle

Clin Orthop

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

J Bone Joint Surg Am

Arthoscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary study

Knee Surg Sports Traumatol Arthrosc