Biochemical, biomechanical and histological properties of osteoarthritic porcine knee cartilage: implications for osteochondral transplantation

Introduction Cartilage lesions of the knee joint are frequently observed during arthroscopy and when surgical intervention is required, osteochondral autograft procedures are an established method of treatment. Frequently lesions are located on the medial femoral condyle (MFC), and typical donor locations for osteochondral grafts include the medial and lateral patellar groove. This technique provides good results, even when the quality of cartilage transplanted from an osteoarthritic joint is doubtful. This study characterizes biological, biomechanical and histological properties of cartilage explants from the patellar groove harvested from osteoarthritic joints. Materials and methods Cylindrical cartilage explants were harvested from the arthritic areas of the MFC as well as normal appearing regions of the medial and lateral patellar groove from porcine joints revealing various grades of osteoarthritis. Matrix synthesis rates were determined, and explants were investigated by mechanical testing and histology. Results Articular cartilage obtained from the typical donor areas of the medial and lateral patellar groove provided constant enhanced material properties, matrix synthesis rates and histological appearance compared to samples from the arthritic lesions of the MFC, even in joints with end-stage osteoarthritis of the MFC. No significant difference was found between patellar groove cartilage samples harvested from joints with different stages of osteoarthritis. Conclusion Our findings demonstrate that healthy appearing cartilage from the patellar groove does not undergo significant alterations in material properties due to the arthritic milieu present in osteoarthritic joints. Accordingly these locations provide a source of functional tissue for transplant procedures even in joints with end-stage osteoarthritis.     

The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques

Introduction: Most of all osteochondral talar lesions are located in the middle and posterior area of the talar surface. Malleolar osteotomy is often used to access the defect but may be associated with malunion or secondary osteoarthritis. We present an alternative approach to the talus with temporary removal and replacement of a tibial bone block and compare it with other anterior approaches described in the literature. Patients and methods: Thirteen patients (5 males, 8 females) with an average age of 27.2 years and an osteochondral talar lesion were included in our study. All patients were previously operated on the same ankle. Ten lesions were caused by a sports injury. The average follow up was 45 months. The patients were evaluated before and after surgery using the ankle and hindfood score (AOFAS). For the analyses baseline clinical data were compared with follow up data using the Wilcoxon test. Results: The overall improvement between the preoperative and postoperative AOFAS scores was an average of 34.9 points (P=0.0002). No complications occurred at the site of the tibial bone block and the donor site at the talus. There were no patients with recurrence or an ankle osteoarthrosis in the follow up period. Conclusion: The removal of a tibial bone block and its subsequent replacement is a useful technique to access osteochondral talar lesions for osteochondral transplantation for which arthroscopic interventions have failed. The results are comparable to other anterior approaches described in the literature.An erratum to this article can be found at     

Pulsing direct current-induced repair of articular cartilage in rabbit osteochondral defects

Osteochondral defects in the distal femoral condyles of rabbits exposed to a pulsing direct current exhibits an enhanced quality of repair. The signal, with a peak value of 2 microA repeating at 100 Hz, imposed an electric field in the tissue of 20-60 mV/cm2. Maximum efficacy was seen with a shorter period of exposure (40 vs. 160 h) initiated 48 h after surgery for 4 h/day. Repair tissue originated primarily from metaplasia of subchondral elements although hyperplasia of pre-existing chondrocytes at the margins of the defect could be detected. Defects in treated joints contained Safranin O staining material that was histologically similar to a disorganized hyaline cartilage. Central areas of the defects in control animals contained Safranin O-negative material that generally extruded over the surface as a pannus. The edges of nontreated defects also had characteristics of cartilaginous healing, stressing the importance of using serial sectioning techniques in this model of cartilage repair.     

No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus

Introduction Osteochondral transplantations, albeit technically challenging, appear promising not only in knee joint lesions, but also in the treatment of talus lesions. We hypothesized that in patients suffering osteochondral lesions of the talus, favorable outcomes are obtained in patients undergoing primary mosaicplasty as compared to patients undergoing secondary mosaicplasty. Materials and methods Over a 3-year period (1998–2001), 14 patients (six male, eight female, median age 22 years) were treated with an autologous osteochondral transplantation of the talus. Eight patients were previously untreated (group I). Six patients had previous ankle procedures, such as microfracturing (group II). The median follow-up was 24 months and 100% complete at 12 months. The functional outcome was evaluated at least at 6 weeks, 12 weeks, and 1 year after surgery using pain on a visual analog scale (VAS) and sports activity was recorded at 1 year after surgery. In ten patients, magnetic resonance imaging (MRI) of the ankle was performed at 1 year after surgery (group I/II: 7/3). Results Overall ankle pain was decreased from 6.9 ± 2.1 to 4.0 ± 2.8 postoperatively. The mean knee pain for the donor knee was 2.6 ± 2.4. We found no significant difference between the primary mosaicplasty group and the secondary mosaicplasty group with regard to pain. MRI scans of ten patients showed a complete incorporation of the osteochondral cylinders at 1 year after surgery. Conclusion Favorable outcomes were obtained in patients undergoing primary mosaicplasty as compared to patients undergoing secondary mosaicplasty. We found no significant difference among patients with previous ankle surgery in contrast to those without, with a median 24-months follow-up.     

A 2-staged method for treatment of deep osteochondral lesions of the knee joint

We performed a 2-staged arthroscopic-assisted surgical procedure to treat a patient with a large osteochondral lesion of the knee joint. The osteochondral lesion was too comminuted to reattach; in addition, the underlying bony defect was too deep. In the first stage, autogenous cortical bone was used for grafting the bony defect along with screw fixation. The second stage consisted of screw removal and transplantation of autogenous osteochondral graft overlying the chondral defect. The osteochondral grafts were taken from the non–weight bearing areas of the same knee.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: E35     

Establishing proof of concept: Platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus

Osteochondral lesions of the talus are common injuries in the athletic patient. They present a challenging clinical problem as cartilage has a poor potential for healing. Current surgical treatments consist of reparative (microfracture) or replacement (autologous osteochondral graft) strategies and demonstrate good clinical outcomes at the short and medium term follow-up. Radiological findings and second-look arthroscopy however, indicate possible poor cartilage repair with evidence of fibrous infill and fissuring of the regenerative tissue following microfracture. Longer-term follow-up echoes these findings as it demonstrates a decline in clinical outcome. The nature of the cartilage repair that occurs for an osteochondral graft to become integrated with the native surround tissue is also of concern. Studies have shown evidence of poor cartilage integration, with chondrocyte death at the periphery of the graft, possibly causing cyst formation due to synovial fluid ingress. Biological adjuncts, in the form of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), have been investigated with regard to their potential in improving cartilage repair in both in vitro and in vitro settings. The in vitro literature indicates that these biological adjuncts may increase chondrocyte proliferation as well as synthetic capability, while limiting the catabolic effects of an inflammatory joint environment. These findings have been extrapolated to in vitro animal models, with results showing that both PRP and BMAC improve cartilage repair. The basic science literature therefore establishes the proof of concept that biological adjuncts may improve cartilage repair when used in conjunction with reparative and replacement treatment strategies for osteochondral lesions of the talus.     

Chondral defects of the knee treated by transplantation of autogenous osteochondral plugs

Objective  Complete, lasting coverage of chondral defects of femoral condyles with hyaline cartilage. Indications  Pain, disturbance of function due to chondral defects of weight-bearing joint sections grade III and IV according to Outerbridge and osteochondritis dissecans stage 4 and 5 according to Rodegerdts & Gleissner. Contraindications  Arthritis, infection, preexisting and persisting instability, axial malalignment. Surgical Technique  Anteromedial or anterolateral arthrotomy to evaluate the size of the chondral defect, removal of the cartilage defect by cutting out cartilage-bone cylinders with the Twin Diamond Transplantation Technique (TDTT). Harvesting of appropriately sized cartilage-bone cylinders with healthy hyaline cartilage from non-weight-bearing areas of the posterior or anterior articular surface with the TDTT. Transplantation of the cartilage-bone cylinder “press-fit” into the prepared defect without further fixation. Refilling of the defects caused by harvesting with corresponding periosteum-covered bone cylinders from the iliac crest or with bone substitute materials. Results  In 1996 and 1997, 20 patients with cartilage damage of a femoral condyle were treated by osteochondral cylinder transplantation. All 20 patients were questioned as to their subjective assessment of the outcome and reexamined 6, 12, and 24 months postoperatively. The evaluation of the results was performed using Meyers and Lysholm scores and the Tegner activity scale 3, 6, 12, and 24 months postoperatively. Five women and 15 men had cartilage defects measuring from 3.22 to 4.25 cm². 24 months postoperatively, 17 patients felt significant and three patients slight improvement. According to the evaluation criteria of the Meyers score, results in five patients were considered excellent, in 13 good, and in two moderate. According to the Lysholm score, 15 patients were judged as being excellent and five as being good, and according to the Tegner activity scale, nine were considered excellent, nine good, and two moderate. Reasons for the two moderate results were remaining activity-related pain and knee flexion limited to 120°. In both patients an additional osteochondral cylinder had been harvested from the posterior aspect of a femoral condyle.     

Allogenous bone with collagen for repair of deep osteochondral defects

Background

A scaffold for treatment of deep osteochondral defects should be stable, integrate well, and provide a surface for chondrocytes. To meet these demands, a biphasic scaffold of allogenous sterilized bone with a collagen surface was developed. Integration was tested in the sheep model.

Material and methods

Cartilage chips were taken from the nonweight-bearing area of the left knee of 12 sheep and cultured. After 4 wk a second procedure followed and defects of 9.4-mm diameter at the weight-bearing area of the medial femoral condyle of the right knee were created. The sterilized scaffold was inserted and the cultured autologous chondrocytes were dripped onto the surface. After 6 wk, 3 mo, and 6 mo the animals were sacrificed; the explanted femoral condyles were evaluated macroscopically and using histologic, immunohistochemical, and electronmicroscopic methods.

Results

After 6 wk the level of the surface was well preserved, after 3 mo parts of the scaffold were sintered but after 6 mo the surface was continuous. Full integration of the allogenous bone could be observed after 6 mo. The surface of the scaffold after 6 wk consisted of bone, but after 3 mo some chondrocytes and after 6 mo a continuous chondral layer could be detected.

Conclusions

The biphasic scaffold of allogenous bone and collagen proved to be stable and sufficiently integrated in the short- and midterm interval. Whether the chondrocytes on the surface had been derived from implanted chondrocytes or the scaffold with its surface was sufficiently chondroconductive must be answered in further investigations.     

Effects of osteochondral defect size on cartilage contact stress

Contact stress distributions were studied in vitro for 13 dog knees, with full-thickness osteochondral defects drilled in the weight-bearing area of both femoral condyles. Diameters of the circular defects were concentrically enlarged from 1 to 7 mm. Digitally-imaged Fuji film was used to record cartilage contact stress distribution on femoral condyles for each increment of defect diameter. All specimens showed at least some tendency for contact stress concentration at the rim of the defects. However, detailed distributions had large interspecimen variability and, within a given specimen, contact stress distributions became progressively more nonuniform around the defect rim as the diameter was enlarged. Averaged over the full series of 26 condyles, circumferential mean cartilage contact stress around the defect rim was only moderately higher (by 10-30%) than intact surface's peak local contact stress [series average = 6.2 mega pascals (MPa)]. Maximal rim stress concentration occurred for 2 mm defects, there being a consistent trend toward mild rim stress decrease with further defect enlargement. Such modest contact stress elevations, per se, are probably insufficient to inhibit defect repair or to cause degeneration of surrounding cartilage. However, near the defect rim (for all diameters), the radial component of the gradient of contact stress (i.e., radial-direction variation of contact stress) was consistently elevated by an order of magnitude above that for intact, condyle articular cartilage.     

自体骨髓基质干细胞辅助Mosaicplasty技术促进骨软骨缺损修复整合

目的探讨以基于骨髓基质干细胞(BMSCs)的组织工程技术与自体骨软骨柱镶嵌移植术(Mosaicplasty)相结合的方法修复骨软骨及促进缺损间隙的整合效果。方法12只中国山羊于术前2周抽取骨髓,体外培养自体BMSCs。术中以自制器械分别制造山羊双后肢股骨内髁负重区直径5 mm、深3 mm的复合骨软骨缺损各一处。在Mosaicplasty技术填充缺损后,即以动物自体BMSCs与透明质酸凝胶相复合,注射填充于左后肢骨软骨柱之间及与周围组织的间隙内,右后肢单纯自体骨软骨柱移植作为对照组。术后第4、8、16周分别取材进行组织学、组织化学及蛋白聚糖含量等检测。比较16周时两组的缺损区惨复软骨组织与正常软骨的蛋白聚糖含量。结果两组自体骨软骨柱移植软骨均以透明软骨存活,与周围正常软骨间无明显差异。实验组骨软骨柱的间隙内可见新生软骨修复,组织学表现与周围正常软骨相同。交界区整合良好,间隙消失;对照组各时间点软骨间的间隙为纤维组织或纤维软骨填充,仍有间隙存留。移植软骨的基质、实验组骨软骨柱间隙内的新生软骨基质及Ⅱ型胶原免疫组化染色均为阳性。蛋白聚糖含量比较显示,对照组骨软骨柱间隙内新生组织的蛋白聚糖含量均低于正常软骨和实验组,差异有显著性意义(P< 0．05)。结论基于BMSCs的组织工程技术结合Mosaicplasty技术,可以有效地促进骨软骨缺损间隙的整合,改善修复效果好,有望成为一种理想的促进骨软骨缺损修复的方法。     

Cell-based treatment of osteochondral defects in the rabbit knee with natural and synthetic matrices: cellular seeding determines the outcome

Introduction: Matrix-associated transplantation of cartilage constructs is an appealing method in cartilage repair. Three different matrices seeded with allogenic chondrocytes were compared in an osteochondral defect model in the rabbit. An investigation was conducted to identify the best matrix for cell-based treatment of osteochondral defects in the rabbit knee joint. Materials and methods: Osteochondral defects (diameter 3 mm) were created in the trochlea and the femoral condyles of 33 New Zealand White rabbits, which were then treated with bioartificial cartilage constructs. The cartilage constructs were created in vitro using three different resorbable carrier materials (two fleece matrices: one of PLLA, and one composite of polydioxanon/polyglactin, as well as one consisting of lyophilized dura) cultured with isolated allogenic chondrocytes. The defects were evaluated macroscopically, by histological and immunhistological techniques, and by scanning electron microscopy after 6 weeks, 6 months, and 12 months. The chondrocyte-seeded constructs were compared to defects treated with carrier material alone as well as to untreated control defects. Results: There was a significant improvement in defect repair quality in the transport materials, which were cultured with chondrocytes prior to implantation (P<0.0005). No significant differences were observed between the three carrier matrices, and no significant differences were seen between the unseeded matrices and the untreated control defects. Conclusion: There is no difference in the outcome between the three tested matrices in the treatment of osteochondral defects in the rabbit knee. The results of this in vitro experiment are promising and with refinement may lead to useful clinical therapies.     

自体骨软骨镶嵌移植修复猪膝关节骨软骨缺损

目的: 探讨猪自体骨软骨镶嵌移植治疗股骨负重区骨软骨复合缺损的优缺点。方法: 采用德国Arthrex公司OATS软骨移植器械, 进行长枫杂交仔猪同关节非负重区骨软骨移植修复负重区骨软骨缺损。结果: 12周后发现骨软骨柱移植后存活良好, 移植软骨中心区无明显凹陷及退变, 甚至稍有凸起, 质地同正常软骨; 与周围正常软骨界限仍清晰, 交界区软骨整合差, 有明显裂隙存在; 骨软骨供区有明显凹陷, 为白色组织充填, 质软, 周围可见正常软骨退变。结论: 自体骨软骨镶嵌移植具有移植软骨固定可靠、软骨细胞存活率高等优点, 但也有交界区整合差, 为纤维软骨修复等缺点。     

The treatment of intractable plantar fasciitis with platelet-rich plasma injection

BackgroundWhilst most cases of plantar fasciitis can be settled with existing conservative treatment, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue problems.ObjectiveEvaluate the effectiveness of platelet rich plasma (PRP) in chronic cases of plantar fasciitis.Patients and methodsPatients with plantar fasciitis not responded to a minimum of 1 year standard conservative management were offered PRP therapy. Injections were performed in theatre as a day case. Roles–Maudsley (RM) scores, Visual Analogue Scores (VAS), AOFAS scores and ‘would have injection again’ were collated pre-operatively, three and six months.ResultsProspective data was collected of 50 heels (44 patients). At six month review, RM score improved from mean 4 to 2 (p < 0.001), VAS improved from 7.7 to 4.2 (p < 0.001) and AOFAS improved from 60.6 to 81.9 (p < 0.001). 28 patients (64%) were very satisfied and would have the injection again.No complications were reported.ConclusionIn these chronic cases, PRP produce an efficacy rate, approaching 2 out of every 3. The procedure was safe with no reported complications. The authors feel PRP may have some role in treatment, and merits further study with a prospective randomised trial.     

The regenerative effect of platelet-rich plasma on healing in large osteochondral defects

Platelet-rich plasma (PRP), a platelet concentrate made of autogenous blood, has been used to improve bone and soft tissue defect healing in recent years. The aim of this study was to assess the effect of PRP on articular cartilage defects in a rabbit model. Forty-eight osteochondral defects created in the femoropatellar groove were (a) left untreated, (b) treated with autogenous PRP in a poly-lactic-glycolic acid (PLGA), or (c) with PLGA alone. Platelets were enriched 5.12-fold compared to normal blood in the PRP. After four and 12 weeks, the explanted tissue specimens were assessed by macroscopic examination, micro-computed tomography, and histological evaluation. Macroscopic examination, micro-computed tomography and histology of the newly formed cartilage and bone in the defect differ significantly between the PRP-treated and the untreated groups, and stimulatory effect of PRP on osteochondral formation was observed. In conclusion, PRP in PLGA improves osteochondral healing in a rabbit model.     

富血小板血浆在足踝外科临床应用中的研究进展

富血小板血浆是利用自身全血制作的富含血小板的高浓度血浆,具有迅速止血、止痛、加速伤口愈合的作用.富血小板血浆能有效促进和加速组织修复,不仅为组织修复提供了“浓缩的营养”,还为组织修复搭建了更好的修复环境.随着富血小板血浆的不断推广,其逐渐被用于骨科治疗肌腱、韧带、软骨及肌肉的损伤.同时,随着近些年足踝外科的迅猛发展,这类应用也逐渐被引入到该领域,富血小板血浆对足踝疾病治疗效果的报道也不断出现,本文就富血小板血浆在足踝方向的临床研究作一综述.     

Combined use of platelet-rich plasma and autologous bone grafts in the treatment of long bone defects in mini-pigs

The use of platelet-rich plasma (PRP) for improving of bone defect healing is discussed controversially. The aim of this study was to assess the effect of PRP in combination with autologous cancellous graft on bone defect healing in a critical metaphyseal long bone defect. A critical size defect in the tibial metaphysis of 16 mini-pigs was filled either with autologous cancellous graft as control group or with autologous cancellous graft combined with autologous PRP. Compared to native blood platelets were enriched about 4.9-fold in the PRP. After 6 weeks, the specimens were assessed by X-ray and histological evaluation. Histomorphometrical analysis revealed that the area of new bone was significantly higher in the PRP group concerning the central area of the defect zone (p < 0.02) as well as the cortical defect zone (p < 0.01). All defects showed substantial new bone formation, but only defects of the PRP group regenerated entirely. The PRP group was superior to the control group even in the semi-quantitative assessment of the osseous bridging in both observed areas of the defect. Within the limits of the present study it could be demonstrated that PRP combined with autologous cancellous graft leads to a significantly better bone regeneration compared to isolated application of autologous cancellous graft in an in vivo critical size defect on load-bearing long bones of mini-pigs.     

富血小板血浆在骨科的研究概况

【摘要】〓富血小板血浆(platelet-rich plasma,PRP)是最近十年研究热门的一个课题,它是一种具有促进组织损伤修复作用的自体来源血浆制品,其所含有的超生理浓度血小板和多种生长因子是发挥作用的主要物质。目前,PRP已在口腔、美容整形、普通外科、骨科及运动医学等临床领域开展应用,其中骨科研究是现阶段数量最多的。一些与骨科相关的体外细胞学实验、体内动物实验和临床研究的结果表明PRP能有效地促进骨及软组织修复,对骨科疾病的治疗效果好,但也有文献报道相反的结论或称目前临床证据不足以评价。因此,PRP在骨科的研究还有许多问题亟待解决,需要开展更多的研究进行探索。     

富血小板血浆凝胶制备及对大鼠皮瓣成活的作用分析

目的寻找制备富血小板血浆(platelet-rich plasma,PRP)的最佳离心方案,并制备PRP凝胶用于皮下注射促进大鼠皮瓣成活,探讨其有效性及作用机制。方法取12周龄健康Wistar大鼠72只,体重250～300 g。于24只大鼠心脏取动脉血8～10 mL/只,分别采用3种离心方法制备PRP。A组:以200×g离心15 min、500×g离心10 min;B组:以312×g离心10 min、1 248×g离心10 min;C组:以200×g离心15 min,200×g离心10 min。在PRP制作过程中取各组全血、PRP及贫血小板血浆(platelet-poor plasma,PPP)行血小板计数,根据血小板计数结果选择最佳离心方案,并取对应的PRP、PPP及第1次离心后血清,采用ELISA法测定PDGF-BB和TGF-β1浓度;并制备PRP及PPP凝胶。于48只大鼠背部制备大小为11 cm×3 cm的皮瓣,随机分为3组(n=16):PRP组每只大鼠皮瓣下注射100 mL PRP凝胶,PPP组同法注射100 mL PPP凝胶,对照组不作处理。术后大体观察皮瓣成活情况,7 d后取材计算成活率;组织学观察计数炎性细胞,免疫组织化学染色计数微血管;于术后8、24 h,3、7 d行实时荧光定量PCR检测VEGF、EGF、PDGF-AA和PDGF-BB mRNA表达。结果血小板计数结果示,A组血小板浓缩倍数最高,为最佳制备方法。A组PRP中TGF-β1、PDGF-BB浓度明显高于血清及PPP(P<0.05)。与对照组相比,术后PRP组伤口无脓性分泌物;PRP组皮瓣成活率为61.2%±9.1%,与PPP组35.8%±11.3%及对照组28.0%±5.4%比较,差异有统计学意义(P<0.05)。PRP组炎性细胞计数较PPP组及对照组明显减少,微血管计数明显高于其余两组,差异均有统计学意义(P<0.05)。实时荧光定量PCR检测示与PPP组及对照组比较,PRP组VEGF及PDGF-BB mRNA术后均高表达,而EGF mRNA仅在术后24 h内呈高表达,PDGF-AA mRNA在3 d后开始高表达。术后3 d及7 d PRP组PDGF-AA、8 h PDGF-BB、24 h及3 d VEGF、24 h EGF的mRNA相对表达量与其他两组比较,差异有统计学意义(P<0.05)。结论以200×g离心15 min、500×g离心10 min是制备PRP的最佳离心方案。PRP凝胶可通过调节血管生发相关基因促进大鼠皮瓣成活。     

富血小板血浆治疗症状性宫颈内膜移位的研究

目的：评价自体富血小板血浆注射对症状性宫颈内膜移位的治疗疗效。方法收集128例诊断为Ⅲ度症状性宫颈内膜移位患者,随机分为自体富血小板血浆（PRP）注射组（实验组）和微波组（对照组）,阴道镜评估宫颈糜烂区愈合情况,应用Kirby-Baue抑菌圈试验评价PRP的抗菌性能,采用LIVE/DEAD BacLight死活菌试剂盒检测生物膜中细菌活力。结果 PRP体外具备良好的抗菌性能,临床随访表明PRP组和微波组6周后总有效率为96.8%（60/62）和80.0%（48/60）,差异具有统计学意义（χ2=9.206,P＜0.05）,富血小板血浆组宫颈创面愈合速度（5.3＆#177;2.1周）较微波组（7.9＆#177;2.8周）显著加快（χ2=7.206,P＜0.01）;PRP组治疗相关的不良反应（阴道分泌物及出血等）显著低于微波组,提示PRP具有很好的耐受性和安全性。结论自体PRP对治疗症状性宫颈内膜移位具有良好的应用前景。     

Osteochondral autografts transfer for post-traumatic osteochondral defect of the knee-2 to 5 years follow-up

The treatment of post-traumatic osteochondral defects of the weight-bearing surface of the knee in young active patients remains a significant challenge. We report the results of an osteochondral autograft transfer (OAT) in 18 patients (mean age 29 years) with post-traumatic focal osteochondral defects of the knee. Sixteen lesions were over the femoral condyle and two were over the tibial plateau. The average size of the lesion was 4.1 cm² (from 2.25 to 6 cm²), and the subchondral bone involved no more than 1 cm in depth. Osteochondral grafts were harvested from the non-weight-bearing area of the femoral condyle. Ten patients also had concomitant surgical procedures. The average follow-up was 42 months (from 24 to 64 months). All patients were evaluated by Lysholm and Tegner activity scores and plain radiographs. Nine patients had MRI, eight patients had second-look arthroscopy and two had a biopsy. Sixteen patients (89%) had good to excellent results, while two patients with lesion over the tibial surface had fair results. The biopsy revealed survival of hyaline cartilage. For small to medium osteochondral lesion over the femoral condyle of the knee in selected patients, osteochondral autografting yielded promising short to mid-term results.