Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: A 2- to 5-year follow-up study

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Purpose: The purpose of this retrospective analysis was to evaluate the medium-term results of arthroscopic treatment of chondral and osteochondral lesions of the knee with autogenous osteochondral transplantation (AOT). Type of Study: Case series. Methods: Thirty-three skeletally mature patients with symptomatic, full-thickness cartilage lesions of the femoral condyles, between 1 and 2.5 cm in diameter, were treated with arthroscopic AOT. Grafts were harvested from the superior and lateral intercondylar notch and press-fit into holes drilled into the defect. All patients were evaluated both preoperatively and postoperatively with the Lysholm knee score, International Knee Documentation Committee (IKDC) Standard Evaluation Form, and knee joint radiographs. Results: Thirty patients of a mean age of 44.6 years were followed-up for a mean time of 45.1 months. Symptom duration ranged from 1 month to 15 years (median, 9.5 months). The mean Lysholm score significantly improved from 43.6 preoperatively to 87.5 postoperatively (P < .001). Excellent or good outcome was accomplished in 25 of the patients (83%). Using the IKDC assessment, 26 of the patients (87%) reported their knee as being normal or nearly normal. Repeat arthroscopy with needle biopsy of the graft was performed in 9 patients. Seven of these had complete healing and 2 partial healing. The histologic examination revealed viable chondrocytes and normal hyaline cartilage in the completely healed cases. Congruency of the articular surface was restored in 11 of 12 patients (92%) who underwent magnetic resonance imaging examination. Abnormal marrow signal in the subchondral bone beneath the region of cartilage repair was present in 9 of 12 patients (75%), even 4 years after the procedure. Conclusions: Arthroscopic AOT is an effective and safe method of treating symptomatic full-thickness chondral defects of the femoral condyles in appropriately selected cases. However, further studies with long-term follow-up are needed to determine if the grafted area will maintain structural and functional integrity over time. Level of Evidence: Level IV, therapeutic, case series (no, or historical, control group).

Section snippets

Study design

This study was initiated in March 1996 and the preliminary results have been previously reported.18 Thirty-three knees in 33 consecutive patients with an arthroscopically established diagnosis of a full-thickness cartilage defect of the femoral condyles were eligible for inclusion in the study and were all treated with arthroscopic AOT from March 1996 to June 1999 by the senior author (J.C.Y.C.).

The inclusion criteria were (1) full-thickness chondral and osteochondral defects demonstrated by

Results

Three of 33 patients (9.1%) were lost to follow-up and were excluded from the study. Thus, 30 patients (30 knees) with a minimum follow-up of 2 years constitute the subjects of this report.

There were 13 male and 17 female patients with a mean age of 44.6 years (range, 19 to 66 years). The age distribution of our patients was as follows: 19 to 34 years, 9 patients; 35 to 44 years, 5 patients; 45 to 54 years, 11 patients; and 55 to 66 years, 5 patients. The procedure was performed in 18 right

Discussion

Full-thickness chondral and osteochondral defects of the knee can cause numerous problems to the patient, such as pain, swelling, and locking, and may lead to early development of osteoarthritis. The goals of treatment are to alleviate pain and improve function, and furthermore to prevent or delay prosthetic replacement of the joint.

A cascade of alternative methods is available to treat chondral lesions but many limitations exist. Techniques for repair stimulation, such as abrasion arthroplasty,

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