Autologous Osteochondral Graft For Focal Articular Cartilage Defect Of The Knee

Background: Full thickness cartilage defect of the knee frequently resulted in fibrous tissue formation, and larger lesions often lead to degenerative arthritis of the knee. Many techniques are designed to repair the cartilage defect including chondrocyte transplantation, microfracture and osteochondral graft. Each method has achieved some success but no universal results. Autologus osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness. Purpose: The purpose of this retrospective study was to evaluate the medium-term results of autologous osteochondral graft for focal contained articular cartilage defects of the knee in 25 patients with 26 knees with 2- to 7-year follow-up Patients and Methods: The cohort consisted of 17 men and 8 women with an average age of 31.3 ± 11.8 (range 20 to 65) years. One patient had bilateral knees. The diagnosis included 9 osteonecrosis, 10 osteochondritis dessicans, and 7 traumatic defects. A 1.0 mm oversized 10 mm long ossteochondral plug was harvested from either from the sulcus terminalis or the intercondylar notch, and implanted into the recipient site The numbers of osteochondral plug ranged from 1 to 3. In larger lesions, osteochondral grafts were implanted in the weight bearing area, and microfracture in non-weight bearing area. Postoperative management included crutch walking with non-weight bearing for 6 weeks, then partial weight bearing for another 6 weeks before full weight bearing. Range of knee motion, quadriceps and hamstring strengthening exercises were encouraged. The evaluations included functional assessment, radiograph of the knee and second look arthroscopy. Results: At follow-up of 52.9 ± 20.3 (range 25 to 84) months, the results were 50% excellent, 35% good, 11% fair and 4% poor. Overall satisfactory results were noted in 85%. The improvements in pain and function of the knee ranged from 8 to 16 weeks after surgery. There was no correlation of the clinical results with the diagnosis of the lesion. However, the lesion size greater than 500 mm 2 is associated with failure. Radiographic degenerative changes were noticed in 6 (23%) and 7 (27%) in medial compartment, 5 (19%) and 5 (19%) in lateral compartment, and 1 (4%) and 2 (8%) in the patellofemoral compartment pre- and postoperatively (P > 0.05). Twelve knees underwent a second look arthroscopy. Of the 11 asymptomatic knees, 8 knees with the defect smaller than 500 mm 2 showed complete bonding of the graft to the adjacent host cartilage, and 3 cases showed minimal fissuring and fibrous tissue formation between graft and host tissue. One symptomatic knee with greater than 500 mm 2 lesion showed extensive fibrous tissue between the graft and host cartilage. Conclusion: Autologous osteochondral graft provides good or excellent results in 85% of patients with focal contained chondral and osteochondral defects of the knee. There was no correlation of the clinical results with the nature of the disease and the size of the lesion smaller than 500 mm 2 . Any lesion larger than 500 mm 2 is prone to poor clinical outcome.