Autogenous Osteochondral Grafting Research Articles

Autogenous Osteochondral Grafting for Treatment of Knee Osteochondritis Dissecans: A Case Series Study.

Although some surgical techniques have been described for the operative treatment of unstable Osteochondritis dissecans (OCD) of the knee, outcomes are variable and are not satisfying totally. The aim of the present study is to evaluate the outcomes of autogenous osteochondral grafting for OCD of the knee. In a case series study, from June 2014 to July 2015, 16 patients with stage II-IV OCD (International Cartilage Repair Society (ICRS)) of the femoral condyle were investigated. Surgical intervention considered in cases of stage III (4 cases) and IV (2 cases) and in stage II (10 cases) ones that were nonresponsive to conservative treatment. At the initial and final visits, the IKDC, Lysholm score and Tegner activity scale were evaluated. The mean preoperative IKDC score (53.4) increased significantly following surgery (84.3) (P<0.001). Based on the IKDC grading system, before the operation, the knee status was graded as nearly normal, abnormal, and severely abnormal in 4, 10, and 2 patients, respectively. At final post-surgical follow up, 15 normal and 1 abnormal knee were documented (P<0.001). The mean Lysholm score increased from 44.3 per operatively to 86.3 (P<0.001).Tegner activity score improved from 2.8±1 pre operatively to 5.6±2 (P<0.001). Surgical treatment of unstable OCD using autogenous osteochondral graft shows successful outcomes. In addition to reliable fixation, it can enhance healing and convert an uncontained lesion to contained one appropriate for autogenous osteochondral grafting with healthy cartilage.

Autogenous Osteochondral Graft Associated with IGF-1 in Induced Articular Cartilage Lesion in Rabbits

Background: Articular cartilage has a limited capacity for regeneration and of the various treatments proposed, none have reached appropriate therapeutic effectiveness. This study aimed to evaluate autogenous osteochondral grafts in intact or macerated format, in association with or without insulin-like growth factor type-1 (IGF-1) in the repair of osteochondral defects induced in the femoral trochlear groove of rabbits.Materials, Methods &amp; Results: Seventeen healthy White New Zealand rabbits were selected for this study. The rabbits were female, six months old, and had an average body weight of 4.5 kg. All 34 stifle joints were subjected to autogenous osteochondral grafting in the femoral trochlear groove. The joints were divided into four groups designated as intact osteochondral graft with IGF-1 (INT + IGF), intact osteochondral graft with physiological solution (INT + FIS), macerated osteochondral graft with IGF-1 (MAC + IGF), and macerated osteochondral graft with physiological solution (MAC + FIS). Serial evaluations were performed by orthopedic and radiographic examination. After 6 and 12 weeks postoperatively, the grafted area was subjected to macroscopic, histological, and immunohistochemical analyses. Although no statistically significant differences were found between the groups in relation to clinical, macroscopic, histological, and immunohistochemical aspects, a tendency of IGF-1 to promote tissue repair was evident. In the radiographic evaluation, the articular surface and the recipient site in both groups with IGF-1 showed significantly more effective filling (P ≤ 0.05). Regardless of the group, collagen type 2 production, as assessed by immunohistochemistry, was found to be appropriate on the grafted articular surface.Discussion: In extensive cartilage lesions, the use of intact osteochondral grafts may be infeasible due to donor site morbidity. An alternative is the use of macerated osteochondral grafts, which cover a larger area and act as a support and cellular source in the repair process. Growth factors have been evaluated in association with grafted tissues to aid tissue repair, and IGF-1 is currently prominent. In the radiographic analysis of the present study, when comparing sites subjected to osteochondral grafting, presence of the whole graft evidenced adequate local filling in all groups. However, graft integration was apparently rapid and effective in the INT + IGF and MAC + IGF groups from the sixth and ninth weeks of the procedure, respectively. In the macroscopic evaluation at the twelfth week, graft integration with the original cartilaginous tissue was more evident, especially in both groups treated with IGF-1. It is likely that the property of IGF-1 to increase chondrogenesis in the cartilage repair of articular lesions in vivo may have contributed to these results in radiographic and macroscopic examinations. Histological examination showed no significant difference between groups in the same period of time; however, it was observed that addition of IGF-1 promoted a more evident tissue reaction and cellular activation, potentiating the process of reabsorption and repair in the grafted tissue. Immunohistochemical analysis showed similar immunoreactivity for collagen type 2 in all groups as early as the sixth week. However, a small portion of these tissues cannot be considered true hyaline cartilage due to the absence of some typical features. In summary, addition of IGF-1 to the autogenous osteochondral graft seemed to stimulate reabsorption and replacement processes in the grafted tissue. The grafts showed adequate ability to repair articular cartilage, displaying formation of collagen type 2 similar to that in the original tissue.

Treatment of unstable osteochondritis dissecans in adults with autogenous osteochondral grafts (Mosaicplasty): long-term results.

the unstable osteochondritis dissecans (OCD-type II and III according to the ICRS classification) of the knee largher than > 2.5 cm(2) in adults are uncommon lesions and there is no consensus on how to treat them. Medium-term studies have reported good results using autogenous osteochondral plugs (mosaicplasty). The aim of this study is to analyze the long-term results of this technique for the treatment of unstable OCD in a selected group of adult patients. four patients with OCD at either one of the femoral condyles were included in this prospective study. The average age was 21.2 years (range, 18-24 years). The OCD lesions were classified as type II in three patients and type III in one patient and the average size was 3.8 cm(2) (range, 2.55-5.1 cm(2)). The lesions were treated in situ with a variable number of autogenous osteochondral plugs (Ø 4.5 mm(2)). The Modified Cincinnati, Lysholm II and Tegner scores were used for clinical and functional evaluation. Magnetic resonance arthrography (MRA) was performed before surgery and at 2, 5 and 10 years after surgery. A modified MOCART score was used to evaluate MRA findings. the average follow-up duration was ten years and 6 months (range, 10-11 years). No complications occurred. At the final follow-up, all scores (clinical, functional and MOCART) improved. In all but one of the patients MRA showed complete osteochondral repair. the fixation of large and unstable OCD lesions with mosaicplasty may be a good option for treating type II or III OCD lesions in adults. The advantages of this technique include stable fixation, promotion of blood supply to the base of the OCD fragment, and grafting of autologous cancellous bone that stimulates healing with preservation of the articular surface. Level IV, therapeutic case series.

A Scaphoid Osteochondral Autograft for Reconstruction of the Lunate Fossa of the Distal Part of the Radius After a Complex Open Fracture: A Case Report.

Complex fractures of the distal part of the radius in high-energy injuries or in elderly osteopenic patients often have extensive articular comminution. Often, these small fragments are not amenable to primary fixation. In high-energy open fractures, there may be substantial bone loss or missing osteochondral fragments. Moreover, concomitant carpal fractures are often present, as well as associated radiocarpal and carpal dislocations that offer additional challenges. Primary total wrist arthrodesis has been suggested for treatment of these difficult injuries1. Motion-preserving salvage procedures include total wrist arthroplasty, limited wrist fusion, and proximal row carpectomy (PRC). Total wrist arthroplasty is contraindicated in younger, more active patients because current implants require a low-demand lifestyle, and complication rates following surgery remain high2. Limited wrist fusion and PRC require an intact lunate fossa and thus may not be options in cases with substantial loss of articular surface. Autogenous osteochondral graft reconstruction of the articular surface of the distal part of the radius has been described in some small case series3-7. PRC involves resection of the scaphoid, lunate, and triquetrum, allowing the capitate to articulate with the lunate facet of the distal part of the radius. The scaphoid is therefore an ideal potential osteochondral donor graft for salvage of the lunate fossa when PRC is to be performed because it does not require a separate graft harvest procedure and does not cause additional donor-site morbidity. We report a case of a complex open radiocarpal fracture-dislocation with bone loss, demonstrating salvage of the lunate facet of the distal part of the radius with a scaphoid osteochondral autograft. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-five-year-old man was involved in a rollover motor vehicle collision and was transferred to …

Matching Articular Surfaces of Selected Donor and Recipient Sites for Cylindrical Osteochondral Grafts of the Femur

Background: Autogenous osteochondral grafting has been widely performed as a treatment for focal osteochondral defects. In this procedure, it is important to match the shape of the articular surface between the donor site and recipient site to reproduce the original articular surface of the femur. Purpose: To investigate the ideal matching patterns of articular surface profiles of donor and recipient sites for autogenous osteochondral grafting of the femur using a 3-dimensional laser scanning method. Study Design: Descriptive laboratory study. Methods: The donor and recipient sites in 11 cadaveric knees were examined, and each of the sites was divided into 12 areas. In the donor sites, the contours of the articular surface of the medial and lateral femoral trochleae were determined. In the recipient sites, the contours of the articular surface of the medial and lateral femoral condyles were assessed. Vertical intervals (VIs) were then calculated as the parameter for the height of the articular surface. The VI was the height difference from the highest and lowest points in the contours of the articular surface within the area of the donor and recipient sites. Finally, assessments were made on whether the articular surface of the donor and recipient sites matched properly for cylindrical osteochondral grafts with diameters of 6, 8, and 10 mm. Results: For the donor site, the VIs of the middle area of the femoral trochlea were significantly smaller than those of the peripheral area. For the recipient site, the VIs of the anterior area of the femoral condyle were significantly smaller than those of the posterior area. Conclusion: These results indicated in aging specimens that the articular surface profile of the middle area of the donor site matched that of the anterior area of the recipient site. On the other hand, the shape of the articular surface of the peripheral area of the donor site was congruent with that of the posterior area of the recipient site. Clinical Relevance: This study will be useful for improving donor site selection during preoperative planning. The authors recommend selection of the middle area of the femoral trochlea for cartilage defects in the anterior area of the femoral condyle and of the peripheral area of the femoral trochlea for cartilage defects in the posterior area of the femoral condyle.

Matching of Articular Surface Shape of Selected Donor and Recipient Sites for Cylindrical Osteochondral Grafts of the Femur -Quantitative Evaluation using a Three Dimensional Laser Scanner

Objectives:Autogenous osteochondral grafting has been widely performed as the treatment of the focal osteochondral defects. In this procedure, it is ideal and important to match the articular surface shape between the donor and recipient site to reproduce the original articular surface of the femur. The purpose of this study was therefore to investigate the ideal matching pattern of the articular surface profile between the donor and recipient site of the femur using a three dimensional (3D) laser scanning method.Methods:Eleven cadaveric knees were employed for this study. The 3D laser scanner was used to obtain 3D profile of the femur. Firstly, we indicate a point of the joint surface from the obtained mesh data and calculate the normal vector of the indicated point. Moreover, we determine an analysis area of a constant diameter from the normal vector, and calculate the vertical interval (VI) from the highest and lowest points along within the analysis area. For the data analysis, we divided the donor and recipient sites into the 12 areas. In the donor site, the peripheral and middle one-third areas of the femoral articular surface in medial and lateral patellofemoral (PF) joint were extracted and additionally, these areas were divided into 3 areas(proximal / interlevel / distal). In the recipient site, the peripheral, middle and central one-third areas of the articular surface in medial and lateral femoral condyle were extracted and moreover these areas were divided into the contact surface to the tibia in knee extension (anterior) and flexion (posterior). VIs were calculated in each area and we investigated the matching of the articular surface between the donor and recipient site for cylindrical osteochondral grafts of 6, 8 and 10 mm diameter.Results:In the donor site, the VIs of the middle area were significantly smaller than those of the peripheral area. In the recipient site, the VIs of the anterior area were significantly smaller than those of the posterior area. (table1). These results showed that the VIs of the middle area in the donor site showed no significant differences with those of the anterior area in the recipient site. Moreover, the VIs of the peripheral area in the donor site showed no significant differences with those of the posterior area in the recipient site. Therefore, the articular surface profile of these areas matched each other (Fig.1). These VIs and matching patterns of the articular surface profile had a similar tendency in all sizes of osteochondral grafts.Conclusion:We demonstrated the matching of the articular surface shape between the donor and recipient site in autogenous osteochondral grafting. This study indicated that the VI of the middle one-third area in the donor site and the contact surface to the tibia in knee extension in the recipient site was small and the articular surface profile of these areas seemed to be congruent. Moreover, the VI of the peripheral one-third area in the donor site and the contact surface to the tibia in knee flexion in the recipient site was large and the articular surface shape of these areas seemed to be fitting. Considering these matching patterns, surgeons should select the donor site fitting the articular surface profile in the recipient site in order to perform ideal cylindrical osteochondral grafts. As a clinical relevance, this study will be useful for improving the donor site selection as a preoperative planning in this technique by using data derived from CT and MRI scans of the knee.

An analysis of surface profile for cylindrical osteochondral grafts of the knee quantitative evaluation using a three-dimensional laser scanner

To investigate the congruency of the articular cartilage surface of the knee between the recipient and donor site during autogenous osteochondral grafting using a three-dimensional (3D) laser scanning. Six cadaveric knees were included in this study. The 3D profiles of the articular surface were obtained by a 3D laser scanner (FastSCAN(®), Polhemus). We divided each of the donor and recipient sites into 6 areas in each. The 2 central areas of the donor site were excluded from evaluation because of the trochlear groove. In the donor site, the peripheral and the middle one-third of the femoral articular surface in the medial and lateral patellofemoral joint were extracted. In the recipient site, the peripheral and the middle one-third of the articular surface in the medial and lateral femoral condyle were assessed. In each recipient area, vertical intervals (VIs) of grafts of 6, 8, and 10mm diameter, showing the distance between highest and lowest point of articular surface were calculated from the data obtained and to the donor sites for matching. ϕ6- and ϕ8-mm grafts The VI of the middle area of the donor site did not differ significantly from that of either the peripheral or the middle area of the recipient site. The VI of the peripheral area of the donor site was significantly higher than that of the peripheral area of the recipient site (p<0.01). ϕ10-mm grafts The VI of the middle area of the donor site was significantly lower than that of the peripheral area of the recipient site. The VI of the peripheral area of the donor site was significantly higher than that of the middle area of the recipient site (p<0.01). An osteochondral graft harvested from the peripheral area of the patellofemoral joint might protrude into the middle area in the recipient site, whereas a ϕ10-mm osteochondral graft harvested from the middle area might be depressed from the peripheral area into the recipient site.

Autogenous osteochondral graft transplantation for steroid-induced osteonecrosis of the femoral condyle: A report of three young patients

Steroid-induced osteonecrosis of the femoral condyle is a relatively uncommon condition and is often difficult to select appropriate treatment especially in young patients. Three young men (aged 25, 18, and 24) presented with severe pain and dysfunction of the knee diagnosed as steroid-induced osteonecrosis of the femoral condyle by magnetic resonance imaging (MRIs). Full-thickness cartilage defects sized 20 × 10, 15 × 10, and 30 × 20 mm respectively were classified as International Cartilage Repair Society Grade IV lesions and treated with osteochondral autograft transplantation. They were treated successfully with osteochondral autograft transplantation certificated by post-operative MRI and second look arthroscopy.

Clinical Outcome and Characteristic Assessment of Autogenous Osteochondral Grafts for Cartilage Injuries

Clinical Outcome and Characteristic Assessment of Autogenous Osteochondral Grafts for Cartilage Injuries

Midterm results of biologic fixation or mosaicplasty and drilling in osteochondritis dissecans

Background:Osteochondritis dissecans (OCD) primarily affects subchondral bone. Multiple drilling, fixation implant or autogenous osteochondral grafts are reported as treatment options. We present the midterm results of cases in which an OCD lesion was treated by osteochondral autograft transfer and drilling.Materials and Methods:Between 2002 and 2006, 14 knees with International Cartilage Repair Society (ICRS-OCD) type II and III lesions were treated in our clinic using osteochondral autograft transfer and drilling by arthroscopic or open surgery. The average age of our patients was 22.14 years (range 17-29 years) and average followup was of 24.3 months (range 11-40 months). Lesion type was ICRS type II in five patients (35.7%) and ICRS type III in nine patients (64.3%). In cases with ICRS-OCD type II lesions, in situ fixation was applied following circumferential multiple drilling, while mosaicplasty was done following debridement and multiple drilling in cases with ICRS-OCD type III lesion. Mosaicplasty was performed in the lesion area by an average of 2.5 (range 1-3) cylindrical osteochondral autografts. Patients were not allowed to perform loading activities for 3 weeks in the postoperative period; movement was initiated by using CPM device in the early phase; full range of motion was achieved in third week, and full weight bearing was permitted in 6 to 8 weeksResults:While 6 and 8 patients were classified preoperatively as fair and poor, respectively, according to Hughston scale, excellent and good results were obtained postoperatively in 10 and 4 patients, respectively. During the followup, no problems were detected in any of the patients in the regions where osteochondral graft was harvested.Conclusion:Biologic fixation or mosaicplasty and drilling as a technique to treatment of the lesion in OCD by osteochondral autograft transfer has resulted in good and excellent clinical outcomes in our patients and it is considered that providing blood flow to subchondral bone by circumferencial drilling leads to an increase in the robustness of biological internal fixation and shortens the duration of recovery.

Effects of Hyaluronic Acid on Restoration of Articular Cartilage in Autogenous Osteochondral Grafting in Rabbit knees

Effects of Hyaluronic Acid on Restoration of Articular Cartilage in Autogenous Osteochondral Grafting in Rabbit knees

Lateral Talar Dome Access Utilizing Temporary Invasive Distraction

Autogenous osteochondral grafting is an operative option for the treatment of osteochondral lesions of the talus (OLT). Graft implantation often requires an osteotomy to gain perpendicular access to the recipient site. The purpose of this study was to determine the relative contributions of soft tissue releases, osteotomies, and invasive distraction on perpendicular access to the lateral talar dome. We hypothesized that temporary invasive distraction (TID) would provide greater perpendicular access than anterolateral arthrotomy alone and similar access compared to an anterolateral tibial osteotomy. Eight fresh frozen cadaveric limb specimens were utilized. An anterolateral arthrotomy was performed and an osteochondral plug was harvested as far posterior as allowed. An additional two Kirschner wires were placed to mark the borders of the area of access. This process was then repeated utilizing: 1) an external fixator for distraction alone, 2) an anterolateral tibial osteotomy alone (with distraction released), and 3) an anterolateral tibial osteotomy (with distraction reapplied). The area accessible as well as the anterior to posterior (AP) access was measured and recorded for each approach. The approach utilizing TID provided greater access than arthrotomy with regard to AP access (p=0.0007) as well as area (p=0.003). The approach utilizing TID alone was equivalent to the anterolateral tibial osteotomy with regard to AP access as well as area. TID combined with osteotomy provided greater access than the TID or osteotomy approaches alone with regard to AP access (p=0.01 and p=0.02, respectively) and greater access than the external fixator alone with regard to area (p=0.02). Temporary distraction utilizing external fixation provides greater perpendicular access than anterolateral arthrotomy and access equivalent to anterolateral osteotomy alone. Utilizing TID may obviate the morbidity and possible complications associated with osteotomy and may prove to be a valuable tool in the treatment of osteochondral lesions of the talus.

A case of stifle osteochondrosis treated by osteochondral autogenous grafting

To describe the one-month morphological appearance of autogenous osteochondral grafting in a dog with stifle osteochondrosis. Osteochondral autografting was performed in one stifle of an eight-month-old dog with spontaneously occurring bilateral osteochondrosis. Histopathological analysis performed one month after surgery confirmed partial integration of the grafts and osteochondral survival. Autogenous osteochondral grafting in stifle osteochondrosis results in acceptable graft survival postoperatively and is worthy of further evaluation.

Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint

Purpose: We wanted to evaluate the outcomes of an autologous osteochondral graft (Mosaicplasty) for treating chondral defects of the femoral condyle and We assessed the factors affecting the clinical results. Materials and Methods: This study enrolled 18 patients (19 cases) who underwent an autogenous osteochondral graft to treat a osteochondral defect in the femoral condyle from July 2000 to June 2006. The average age was 26.2 years old (age range: 16-48 years old). Among the patients, 17 cases were men. In 14 cases, the osteochondral defects were localized in the medial femoral condyle and only 5 cases showed a defect in the lateral femoral condyle. The average size of the osteochondral defects was 4.2 cm 2 (1-13 cm 2 ). The Lysholm knee scoring scale and the Tegner's activity score were applied for clinical evaluation. Further, we carried out simple X-ray for all the cases and we performed MRI in 5 cases for the radiological evaluation. Tthe factors affecting the clinical results were also analyzed and the complications were evaluated. Results: The average follow-up period was 22 months (range: 6-55 months ). Eighten out of 19 cases (94.7%) were able to return to ordinary life. The Lysholm knee scoring scale and the Tegner's activity score indicated much better clinical results for small lesions and for young patients. For the radiological results, all the cases displayed a decrease in the size of radiolucent zones on the follow up X-ray. Among the 5 cases for which an MRI was performed, graft unions were observed in 3 cases, but 2 cases displayed continuous peri-graft edema. Any other complications involving the donor and recipient site were not observed. Conclusion: We conclude that autogenous osteochondral grafting is useful for specific patients depending on the size of the lesion and the patient's age. It is a valuable treatment option for osteochondral defects in the knee joint.

Histological evaluation of spontaneous osteonecrosis of the medial femoral condyle and short-term clinical results of osteochondral autografting: A case series

Although many surgical modalities for spontaneous osteonecrosis of the knee (SONK) of the medial femoral condyle have been reported, few reports have described these treatment options from the etiological point of view. Recently, osteochondral autografting has gained popularity for use in small cartilage injuries. The aims of this study were to characterize the SONK lesion histopathologically and to report on preliminary clinical results of autogenous osteochondral grafting for SONK. Six patients with SONK of the medial femoral condyle underwent osteochondral autografting. Average age was 54.2 years (range, 50–57 years). Using Koshino's classification, three patients' lesions were classified as stage III and three as stage IV. Classical histological investigation of the lesions was performed in all cases. All the patients achieved favorable pain relief after osteochondral autografts. The mean duration of follow-up was 27.7 months (range, 23–45 months). An increase in the average Lysholm score was found, ranging from 54.7 preoperatively to 92.3 postoperatively. Histological investigation of the lesions revealed articular bone plate fracture with enchondral ossification, reactive cartilage tissue formation, and proliferation of fibrous tissue. An area of osteonecrosis was observed in detached or fragmented osteochondral lesions. Osteochondral autografting was performed on six patients for the SONK and the short-term clinical results were favorable. Histological results give support to subchondral fracture as the etiological mechanism underlying SONK.

Freiberg's Infraction of the Second Metatarsal Treated with Autologous Osteochondral Transplantation and External Fixation

Freiberg's infraction is a rare disorder of the lesser metatarsals that typically occurs in adolescent females. Many surgical procedures have been employed to treat this condition and have met with varying degrees of success. The authors describe the use of an external fixation device for distraction of the joint in combination with transplantation of an autogenous osteochondral graft for a 15-year-old female with Freiberg's infraction.

Autogenous Osteochondral Grafting for Treatment of Stifle Osteochondrosis in Dogs

To develop and assess clinical outcomes for osteochondral autografting for treatment of stifle osteochondrosis (OC) in dogs. Retrospective case series. Dogs with stifle OC (n=10). Osteochondral autografting was developed and optimized in canine cadavers and purpose-bred research dogs using the Osteochondral Autograft Transfer System (OATS). Dogs with stifle OC (n=10 dogs, 12 stifles) were then treated using the OATS system. Outcomes were assessed by radiography (n=12), magnetic resonance imaging (1), second-look arthroscopy (9), lameness scoring (12), and telephone survey of owners (10 clients, 12 stifles) 6-15 months after surgery. Complications were documented in 4 of the 12 stifles treated and included peri-incisional seromas (3) and marked stifle effusion (1). Subjective assessment of follow-up radiographs revealed evidence of integration of the grafts with maintenance of subchondral bone surface architecture. Subjective assessment of follow-up MRI in 1 stifle revealed evidence for incorporation of grafts with restoration of articular surface contour. Second-look arthroscopy 6-30 weeks after surgery revealed maintenance of articular cartilage at the graft site. Dogs were significantly (P<.001) less lame at follow-up compared with preoperative scores. Based on follow-up owner surveys, only 2 dogs had no pain or lameness; the other dogs were judged to have mild pain and/or lameness. All owners noticed improvement in the dogs' quality of life after surgery. Osteochondral autografting deserves consideration and further evaluation as a primary treatment option for stifle OC in dogs. Osteochondral autografting for treatment of lateral femoral condylar OC lesions in dogs using OATS instrumentation is safe and results in improved function and quality of life based on owners' perception 6-15 months after treatment.

Fixation of Unstable Osteochondritis Dissecans Lesions of the Knee Using Arthroscopic Autogenous Osteochondral Grafting (Mosaicplasty)

A number of surgical techniques have been described for the operative fixation of an unstable osteochondritis dissecans (OCD) lesion in the knee that has failed appropriate nonoperative management. However, no one technique has been universally successful. We report the results of a new fixation technique for unstable OCD lesions using arthroscopic autogenous osteochondral grafting (mosaicplasty). Twenty patients with OCD lesions (16 International Cartilage Repair Society [ICRS] OCD type II, 3 ICRS OCD type III, and 1 ICRS OCD type IV) who had failed an appropriate course of nonoperative management underwent autogenous osteochondral grafting. The OCD lesions were assessed arthroscopically and then fixed in situ by using multiple 4.5-mm osteochondral dowel grafts harvested from the edges of the femoral trochlea. The lesion was initially fixed with an osteochondral graft passing through the center of the fragment and then stabilized by using further grafts inserted around its periphery. Preoperative International Knee Documentation Committee scores assessed 5 patients as nearly normal, 8 as abnormal, and 7 as severely abnormal. At the 18-month follow-up, all of the knees were scored as normal. The average preoperative visual analog pain score out of 10 was 8.3, which was reduced to 0.8 at 6 months and to 0 at 1 year after surgery. Serial magnetic resonance imaging scans showed healing of the bony part of the lesion in all of the knees 6 months after surgery and continuous articular cartilage healing at 9 months. Autogenous osteochondral grafting of unstable OCD lesions in the knee is a reliable and minimally invasive technique that provides a stable biologic fixation using autogenous bone graft and has few complications. Level IV, therapeutic case series.

Mosaicplasty

Basic science and clinical results of autogenous osteochondral graft were reviewed. The operative technique of osteochondral graft gave no bad effect on the grafted plug cartilage in respect of the mechanical properties. In rabbit, the stiffness of grafted cartilage at postoperative 8 weeks was significantly lower than the normal cartilage stiffness, the stiffness at postoperative weeks 12 and 24 was the same as normal cartilage and the stiffness at postoperative 52 weeks was significantly higher than the normal cartilage. In human, the stiffness at postoperative 1 year was the same as normal cartilage. The indication of this procedure was traumatic cartilage defect, osteochondritis dissecans, osteonecrosis and the early stage of osteoarthritis, and the elbow and ankle joints as well as knee joints were also included. The short-term clinical result of this procedure was good, and we had no symptoms on the donor site. However, the long-term follow-up of this procedure is needed.

Non-Contact Evaluation for Articular Cartilage Using Ultrasound

In orthopedic field, various new treatments of articular cartilage defect, for example autogenous osteochondral grafts, have been developed. With the spread of these treatments, orthopedists began to focus on the mechanical properties of recovered articular cartilage. The quantitative evaluation of articular cartilage before and after these treatments gives orthopedists the important information to improve these treatments and develop new treatments. We have been investigating the non-contact ultrasonic evaluation for articular cartilage under arthroscopy. In this paper, it was hypothesized that the ultrasonic evaluation depended on the collagen fiber in cartilage. The enzymatically degradation of collagen fiber in cartilage surface was performed. The effect of the degradation on sound velocity, attenuation coefficient and signal intensity, which is the index of cartilage stiffness calculated from the proposed method, was measured. The numerical analysis was performed to clear the relation between the cartilage character and ultrasonic parameters. Experimental and numerical results suggest that the present method can be expanded the sensitive evaluation for cartilage disease in clinical field.