Abstract
The purpose of this prospective study was to evaluate the results of simultaneous anterior cruciate ligament (ACL) reconstruction and osteochondral autograft transplantation performed in patients suffering an anterior instability associated with symptomatic full-thickness cartilage defects. Our clinical report includes the first 21 patients (six women, 15 men) who have been followed up for 32 months or longer. The average patient age was 29 years (range 22–44 years), and mean time from injury to the combined reconstructive surgery was 10 months (range 4–27 months). The cartilage defects had a mean area of 3.5 cm2 (range 2.0–5.0 cm2). All patients were evaluated according to the IKDC, Lysholm and Tegner scoring scales by an independent observer. A visual analogue scale (VAS) reflecting patient pain was evaluated. Assessment using the IKDC knee scoring scale revealed 81% of the patients with a normal or nearly normal knee joint. There was a significant improvement in subjective discomfort, and the KT-1000 arthrometric evaluation showed a reduction of the ventral tibial translation (5.9 to 1.9 mm). All but two patients had returned to full activities without restriction and were asymptomatic. The results of this study suggest that symptomatic full-thickness articular cartilage defects associated with ACL instability can be effectively treated by performing ACL reconstruction and osteochondral autologous grafts in one procedure. However, only the years which follow will show the long-term outcome of the patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alfredson H, Thorsen K, Lorentzon R (1999) Treatment of tear of the anterior cruciate ligament combined with localized deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation. Knee Surg Sports Traumatol Arthrosc 7:69–74
Bittan ES (2000) Arthroscopic osteochondral grafting of articular cartilage defects in ACL deficient knees. Arthroscopy 16:407–408
Bobic V (1996) Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc 3:262–264
Brittberg M, Faxen E, Peterson L (1994) Carbon fiber scaffolds in the treatment of early knee osteoarthritis. A prospective 4-year follow-up of 37 patients. Clin Orthop 307:155–164
Buckwalter JA, Mankin HJ (1998) Articular cartilage: tissue design and chondrocyte-matrix interaction. Instr Course Lect 47:477–486
Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration, and osteoarthritis, repair, regeneration and transplantation. Instr Course Lect 47:487–504
Curl W, Krome J, Gorden ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460
Daniel DM (1985) Instrumented measurements of the anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407
Graf BK, Cook DA, De Smet AA, Keene JS (1993) Bone bruise on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med 21:220–223
Hangody L, Karpati Z (1994) A new surgical treatment of localized cartilaginous defects of the knee. Hung J Orthop Trauma 37:237–242
Hangody L, Kish G, Karparti Z, Szerb I, Udvarhelyi I (1997) Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc 4:262–267
Hefti F, Müller W, Jakob RP, Staeubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234
Hertel P (1990) A new technique for ACL replacement. Fourth congress of the European Society of Knee Surgery and Arthroscopy, Stockholm, Sweden, 25–30 June 1990
Jakobson K (1977) Osteoarthritis following insufficiency of the cruciate ligaments in man: a clinical study. Acta Orthop Scand 48:520–526
Johnson RJ, Beynnon BD, Nichols CE, et al (1992) The treatment of injuries of the anterior cruciate ligament [Current concepts review]. J Bone Joint Surg 74:140–151
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–501
Kish G, Modis L, Hangody L (1999) Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Clin Sports Med 18:45–66
Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154
Matsusue Y, Yamamurro T, Hama H (1993) Arthroscopic multiple osteochondral transplantation to the chondral defect in the knee associated with anterior cruciate ligament disruption. Arthroscopy 9:318–321
Oberlander MA, Shalvoy RM, Hughston JC (1993) The accuracy of the clinical knee examination documented by arthroscopy. A prospective study. Am J Sports Med 21:773–778
Peterson L, Minas T, Brittberg M, et al (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop 374:312–234
Shelbourne KD, Rowdon GA (1994) Anterior cruciate ligament injury. Sports Med 17:132–140
Spindler KP, Schils JP, Bergfeld JA, Andrish JT, et al (1993) Prospective study of osseous, articular and meniscal lesions in recent anterior cruciated ligament tears by magnetic resonance imaging and arthroscopy. Am J Sports Med 21:551–557
Tegner Y (1985) Cruciate ligament injuries in the knee: evaluation and rehabilitation. Thesis, University of Linköping, Sweden
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Klinger, HM., Baums, M.H., Otte, S. et al. Anterior cruciate reconstruction combined with autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc 11, 366–371 (2003). https://doi.org/10.1007/s00167-003-0422-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-003-0422-3