Abstract
PurposeTo compare the results of two groups of patients affected by osteochondritis dissecans (OCD) of the knee and treated with either osteochondral autologous transplantation (OAT) or bone-cartilage paste grafting (PG).MethodsA total of 27 patients affected by OCD lesions of the femoral condyles were included: 15 treated with OAT, 12 with PG, with comparable baseline characteristics (mean age 22.4 ± 7.2 vs. 24.2 ± 8.5 p = n.s., mean defect size 2.2 ± 1 cm2 vs 2.6 ± 1 cm2p = n.s.). Patients were evaluated pre-operatively and at 24 and 84 months post-operatively with the International Knee Documentation Committee (IKDC) subjective and objective scores. Sport activity level was evaluated with the Tegner activity score. Adverse events and failures were also recorded.ResultsThe IKDC subjective score improved significantly in both groups. At 24 months, a significant improvement from 53.4 ± 9.1 to 80.8 ± 12.9 (p = 0.005) was obtained in the OAT group and from 44.6 ± 11.0 to 71.4 ± 25.3 in the PG group (p = 0.008). A further statistically significant increase was observed at 84 months in both groups. No significant differences were found between OAT and PG at both follow-ups. One OAT patient required post-operative knee mobilization under narcosis and two complained of donor site symptoms. More failures were documented in the PG vs OAT group (25% vs 0%; p = 0.043).ConclusionBoth PG and OAT provided overall satisfactory results up to 84 months follow-up. However, while PG presents the advantages of a less invasive approach with lower adverse events, the higher failure rate of PG should be considered when choosing between these two surgical treatment options for restoration of the articular surface in patients affected by knee OCD.
Highlights
While paste grafting (PG) presents the advantages of a less invasive approach with lower adverse events, the higher failure rate of PG should be considered when choosing between these two surgical treatment options for restoration of the articular surface in patients affected by knee osteochondritis dissecans (OCD)
Knee osteochondral lesions are a common pathology in orthopaedic practice, generally presenting significant functional limitations and pain, with a quality-of-life impairment similar to osteoarthritis (OA) patients scheduled for knee replacement [1, 2]
The main finding of the present study is that both osteochondral autologous transplantation (OAT) and PG provided satisfactory clinical results at mid-term followup in patients affected by knee OCD lesions
Summary
Knee osteochondral lesions are a common pathology in orthopaedic practice, generally presenting significant functional limitations and pain, with a quality-of-life impairment similar to osteoarthritis (OA) patients scheduled for knee replacement [1, 2]. An exemplary instance is represented by osteochondritis dissecans (OCD), a pathologic process of the osteochondral unit, with a multi-factorial aetiology involving both biological and mechanical factors [5, 6] It is characterized by sequestration of subchondral bone, with possible evolution to articular cartilage involvement, and to the detachment of the entire osteochondral unit. The natural history of knee joints after excision of an OCD loose body has shown high rates of OA development and knee arthroplasty at long-term follow-up [7]. This is detrimental, considering that OCD affects especially a young population with long life expectancy. Several bone and cartilage reconstruction procedures have been developed in order to restore the entire osteochondral unit and prevent the detrimental effects of osteochondral defects on joint homeostasis
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