Cylindrical Osteochondral Grafts Research Articles

Functional outcome after arthroscopic mosaicplasty for localized osteochondral defects in the knee

Background: Articular cartilage is complex tissue that is able to withstand tremendous amount of force over many cycle but does not have the ability to heal even after minor injury. Treatment recommendation for articular cartilage injury and arthritis includes non-operative and operative management. Mosaicplasty is a reconstructive osteochondral grafting procedure for the treatment of articular defects of the knee. Mosaicplasty entails transplantation of small cylindrical osteochondral grafts from the non-weight bearing area of the femoral condyles and transplanting them in a mosaic like fashion into a prepared defect site on the weight-bearing surfaces of the same knee. Methods: The present study was carried out in 30 patients in our hospital prospectively to determine the functional outcome results after arthroscopic mosaicplasty for localized osteochondral defects in the knee. We conducted a prospective study on 30 patients of osteochondral defect of knee. Patients were presented with pain and recurrent swelling in the knee after sustaining twisting injury in the knee. Diagnostic arthroscopy was done and the osteochondral defects is localized and treated with mosaicplasty. The graft is harvested arthoscopically from the non-weight bearing part of the femoral condyles using a harvester. Follow up of these patients is done according to Tenger Lysholm knee scoring scale at 03 months, 06 months after surgery. Results: In our study 93.33% patients showed good to excellent results and 7% patients had fair and poor results. Conclusions: Advantage of arthroscopic mosaicplasty includes implantation of hyaline cartilage without the need for any suture or adhesive, need for smaller incision minimally invasive and very less complications. Associated injuries like ACL/PCL or meniscal tear can be addressed in the same procedure. To conclude arthroscopic mosaicplasty is excellent procedure to address the focal articular cartilage injuries of knee.

Osteochondral Autograft Transplantation for Hand and Wrist Articular Problems.

Management of hand and wrist avascular necrosis with osteochondral fragmentation or focal arthritis can be a challenging problem with a variety procedures described for its treatment. Osteochondral autograft transplantation systems have been utilized in various focal defects of the knee, ankle, elbow, and wrist. The same principle for the treatment of focal defects of the proximal scaphoid, proximal capitate as well as metacarpal head as an alternative treatment is described. The main indication for this treatment is to address focal or partial osteochondral defects where the size of the defect is smaller than the isthmus of the involved bone to accommodate a cylindrical osteochondral graft that can be press fit. Larger and complete defects are contraindications to this treatment. We discuss the surgical technique as well as its main indications and expected outcomes.

Developmental engineering of living implants for deep osteochondral joint surface defects.

The repair of deep osteochondral joint surface defects represents a significant unmet clinical need. Importantly, untreated lesions lead to a high rate of osteoarthritis. The current strategies to repair these defects include osteochondral autograft transplantation or "sandwich" strategies combining bone autografts with autologous chondrocyte implantation, with poorly documented long-term outcomes. In this study, we first investigated the capacity of juvenile osteochondral grafts (OCGs) to repair osteochondral defects in skeletally mature rats. With this regenerative model in view, we produced a new biological, bilayered and scaffold-free Tissue Engineered construct (bTEC) for the repair of a deep osteochondral defect of the rat knee. Cylindrical OCGs were excised from the femoral intercondylar groove of the knee of skeletally immature rats (5weeks) and transplanted into osteochondral defects created in skeletally mature rats (11weeks). To create bTECs, micromasses (μMasses) of human periosteum-derived progenitor cells (hPDCs) and human articular chondrocytes (hACs) were produced in vitro using previously optimized chemically defined medium formulations containing growth and differentiation factors including bone morphogenetic proteins. These two μMass types were subsequently implanted as bilayered constructs into osteochondral defects in nude rats. At 4 and 16weeks after surgery, the knees were collected and processed for subsequent 3D imaging analysis and histological evaluation. Micro-computed tomography (μCT), H&E, and Safranin O staining were used to evaluate the degree and quality of tissue repair. The osteochondral unit of the knee joint in 5weeks old rats exhibits an immature phenotype, displaying active subchondral bone formation through endochondral ossification and the absence of a tidemark. When transplanted into skeletally mature animals, the immature OCGs resumed their maturation process, i.e., formed new subchondral bone, established the tidemark, and maintained their Safranin O-positive hyaline cartilage at 16weeks after transplantation. The bTECs (hPDCs + hACs) could partially recapitulate the biology as seen with the immature OCGs, including the formation of the joint surface architecture with typical zonation, ranging from non-mineralized hyaline cartilage in the superficial layers to a progressively mineralized matrix at the interface with a new subchondral bone plate. Cell-based TE constructs mimicking immature OCGs and displaying a hierarchically organized structure comprising of different tissue forming units seem an attractive strategy to treat deep osteochondral defects of the knee.

Radiographic assessment of factors associated with poor outcomes after osteochondral autograft transplantation for capitellar osteochondritis dissecans

Objectives:Osteochondral autograft transplantation (OAT) is a treatment option for large, inviable osteochondritis dissecans (OCD) lesions. Many papers have reported good clinical outcomes after OAT; however, we sometimes experience elbows with poor outcomes that show pain and restricted range of motion. Few articles have investigated factor associated with poor outcomes after OAT. The purpose of this study was to retrospectively investigate the clinical outcome and radiographic findings after OAT in elbows with a large capitellar OCD lesion and to elucidate radiographic factors associated with poor clinical outcomes.Methods:Sixty-nine elbows that underwent OAT for large osteochondral dissecans lesions of the capitellum with a minimum of 2-years follow-up were included in this study. They consisted of 65 males and 4 females with a mean age of 14 (range, 12-15) years at surgery. The mean follow-up was 48 months (range, 24-144). Cylindrical osteochondral grafts were harvested from the lateral condyle of the ipsilateral knee. We usually transplant an 8-mm graft in the lateral part of a lesion and add two 6-mm grafts medial to the initial graft. Clinical outcomes, including elbow range of motion and Timmerman and Andrews clinical rating score (T-A score), were retrospectively investigated. We measured cranial migration of the radial head on the preoperative tangential views. We also evaluated the location and orientation of the most lateral graft on the tangential views at 1 month after OAT: 1) the tilting angle (the angle between the graft axis and the vertical line to the radial articular surface), 2) the distance between the most lateral edge of the graft and the center of radial head, 3) protrusion of the graft from the articular surface of the medial capitellum. The paired t-test and Student’s t-test were used for statistical analysis, and the level of significance was set at p<0.05.Results:The mean elbow extension/flexion significantly improve from preoperative -10/125 to postoperative -5/133 (p<0.001 for each). The mean T-A score significantly improved from preoperative 125±43 to 170±34 at 2 years after surgery (p<0.001). We compared the radiographic findings between good outcomes elbows (T-A score >190, n=33) and poor outcomes elbows (T-A score <150, n=18). The cranial migration of the radial head was 0.2mm and 2.1mm, respectively (p<0.001). The tilting angle was larger in the poor group (18±11 degrees) than the good group (9±8 degrees, p=0.002). The graft was significantly located laterally in the good group (6.8±1.6 mm) than the poor group (3.8±2.3 mm, p<0.001). The protrusion tended to be larger in the poor group (0.2±2.7mm) than the good group (-0.7±1.8mm), but the difference was not significant (p=0.17).Conclusion:The outcomes after OAT was good with significant improvement of range of motion and clinical score, but a quarter of patients showed poorer outcomes. The results of this study indicated that the radial head migration before surgery and the location and orientation of the graft were associated with the clinical outcomes. For better surgical outcomes, OAT should be performed before the radiographic changes progress, and surgeons should be careful about the location and orientation of osteochondral grafts.

Treatment of partial growth arrest using cylindrical costal osteochondral graft

Treatment of partial growth arrest using cylindrical costal osteochondral graft

Cartilage storage at 4°C with regular culture medium replacement benefits chondrocyte viability of osteochondral grafts in vitro.

Maintenance of articular cartilage allografts in culture media is a common method of tissue storage; however, the technical parameters of graft storage remain controversial. In this study, we examined the optimal temperature and culture medium exchange rate for the storage of osteochondral allografts in vitro. Cylindrical osteochondral grafts (n = 120), harvested from the talar joint surface of ten Boer goats, were randomly classified into four groups and stored under the following conditions: Group A1 was maintained at 4 °C in culture medium that was refreshed every 2 days; Group A2 was maintained at 4 °C in the same culture medium, without refreshing; Group B1, was maintained at 37 °C in culture medium that was refreshed every 2 days; Group B2, was maintained at 37 °C in the same culture medium, without refreshing. Chondrocyte viability in the grafts was determined by ethidium bromide/fluorescein diacetate staining on days 7, 21, and 35. Proteoglycan content was measured by Safranin-O staining. Group A1 exhibited the highest chondrocyte survival rates of 90.88 %, 88.31 % and 78.69 % on days 7, 21, and 35, respectively. Safranin O staining revealed no significant differences between groups on days 21 and 35. These results suggest that storage of osteochondral grafts at 4 °C with regular culture medium replacement should be highly suitable for clinical application.

Image-guided techniques improve accuracy of mosaic arthroplasty.

Mosaic arthroplasty is a surgical technique in which a set of cylindrical osteochondral grafts is transplanted from non-load-bearing areas of the joint to repair damaged articular cartilage. Incongruity between the graft surface and the adjacent cartilage at the repair site results in inferior clinical outcomes. This paper compares technical outcome using three mosaic arthroplasty techniques (conventional, optoelectronic, and patient-specific template) on femur models. Three distinct sets of femur models with defects were created. Preoperatively, the harvest and delivery sites were planned using custom software. Five orthopedic surgeons were recruited; each surgeon performed each of the three surgical techniques on each of the three bone models with defect. During the optoelectronic trials, the instrument position and orientation were tracked and superimposed onto the surgical plan. For the patient-specific template trials, plastic templates were manufactured to fit over the defects with cylindrical holes to guide the surgical tools according to the plan. Postoperatively, the femur models were computer tomography and laser scanned. Several measures were made to compare surgical techniques: operative time; surface congruency; defect coverage; graft surface area that is proud or recessed; air volume below the grafts; and distance and angle of the grafts from the surgical plan. The patient-specific template and optoelectronic techniques resulted in improved surface congruency, defect surface coverage, and below-graft air gap volume in comparison with the conventional technique. However, the conventional technique had a shorter operative time. Image-guided techniques can improve the accuracy of mosaic arthroplasty, which could result in better clinical outcomes.

Treatment of local talus osteochondral defects using mosaic autogenous osteochondral plasty

The authors presented the brief incidence analysis of talus osteochondral defect (local joint surface osteonecrosis of the anklebone), its etiology, pathogenesis, symptoms, modern diagnostic algorithm and described proposed surgical procedure. The operation consists of ankle joint arthrotomy, osteonecrotic tissue resection, harvesting of cylindrical mosaic osteochondral graft from low weightbared region of femoral knee joint surface and its implantation into resection cave of the anklebone. The indications to supramalleolar osteotomy for concomitant ankle frontal deformities are grounded. Rigid osteosynthesis and early movements in ankle joint are recommended. Eighteen patients with age from 20 to 58 years old were operated: 8 men and 10 women. In 13 cases (72.3%) the lesion was found in medial edge of talus trochlea, and 5 (27.7%) were lateral lesions. Treatment results of 18 patients evaluated according AOFAS score (H. Kitaoka) improved after operation from (38.2+3.3), to (88.9+3.6) when assessed one year after surgery. Two clinical case reports are presented.

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.

Treatment of Osteochondral Defects in the Rabbit's Knee Joint by Implantation of Allogeneic Mesenchymal Stem Cells in Fibrin Clots

The treatment of osteochondral articular defects has been challenging physicians for many years. The better understanding of interactions of articular cartilage and subchondral bone in recent years led to increased attention to restoration of the entire osteochondral unit. In comparison to chondral lesions the regeneration of osteochondral defects is much more complex and a far greater surgical and therapeutic challenge. The damaged tissue does not only include the superficial cartilage layer but also the subchondral bone. For deep, osteochondral damage, as it occurs for example with osteochondrosis dissecans, the full thickness of the defect needs to be replaced to restore the joint surface 1. Eligible therapeutic procedures have to consider these two different tissues with their different intrinsic healing potential 2. In the last decades, several surgical treatment options have emerged and have already been clinically established 3-6. Autologous or allogeneic osteochondral transplants consist of articular cartilage and subchondral bone and allow the replacement of the entire osteochondral unit. The defects are filled with cylindrical osteochondral grafts that aim to provide a congruent hyaline cartilage covered surface 3,7,8. Disadvantages are the limited amount of available grafts, donor site morbidity (for autologous transplants) and the incongruence of the surface; thereby the application of this method is especially limited for large defects. New approaches in the field of tissue engineering opened up promising possibilities for regenerative osteochondral therapy. The implantation of autologous chondrocytes marked the first cell based biological approach for the treatment of full-thickness cartilage lesions and is now worldwide established with good clinical results even 10 to 20 years after implantation 9,10. However, to date, this technique is not suitable for the treatment of all types of lesions such as deep defects involving the subchondral bone 11. The sandwich-technique combines bone grafting with current approaches in Tissue Engineering 5,6. This combination seems to be able to overcome the limitations seen in osteochondral grafts alone. After autologous bone grafting to the subchondral defect area, a membrane seeded with autologous chondrocytes is sutured above and facilitates to match the topology of the graft with the injured site. Of course, the previous bone reconstruction needs additional surgical time and often even an additional surgery. Moreover, to date, long-term data is missing 12. Tissue Engineering without additional bone grafting aims to restore the complex structure and properties of native articular cartilage by chondrogenic and osteogenic potential of the transplanted cells. However, again, it is usually only the cartilage tissue that is more or less regenerated. Additional osteochondral damage needs a specific further treatment. In order to achieve a regeneration of the multilayered structure of osteochondral defects, three-dimensional tissue engineered products seeded with autologous/allogeneic cells might provide a good regeneration capacity 11. Beside autologous chondrocytes, mesenchymal stem cells (MSC) seem to be an attractive alternative for the development of a full-thickness cartilage tissue. In numerous preclinical in vitro and in vivo studies, mesenchymal stem cells have displayed excellent tissue regeneration potential 13,14. The important advantage of mesenchymal stem cells especially for the treatment of osteochondral defects is that they have the capacity to differentiate in osteocytes as well as chondrocytes. Therefore, they potentially allow a multilayered regeneration of the defect. In recent years, several scaffolds with osteochondral regenerative potential have therefore been developed and evaluated with promising preliminary results 1,15-18. Furthermore, fibrin glue as a cell carrier became one of the preferred techniques in experimental cartilage repair and has already successfully been used in several animal studies 19-21 and even first human trials 22. The following protocol will demonstrate an experimental technique for isolating mesenchymal stem cells from a rabbit's bone marrow, for subsequent proliferation in cell culture and for preparing a standardized in vitro-model for fibrin-cell-clots. Finally, a technique for the implantation of pre-established fibrin-cell-clots into artificial osteochondral defects of the rabbit's knee joint will be described.

Treatment of Osteochondral Defects in the Rabbit's Knee Joint by Implantation of Allogeneic Mesenchymal Stem Cells in Fibrin Clots

The treatment of osteochondral articular defects has been challenging physicians for many years. The better understanding of interactions of articular cartilage and subchondral bone in recent years led to increased attention to restoration of the entire osteochondral unit. In comparison to chondral lesions the regeneration of osteochondral defects is much more complex and a far greater surgical and therapeutic challenge. The damaged tissue does not only include the superficial cartilage layer but also the subchondral bone. For deep, osteochondral damage, as it occurs for example with osteochondrosis dissecans, the full thickness of the defect needs to be replaced to restore the joint surface (1). Eligible therapeutic procedures have to consider these two different tissues with their different intrinsic healing potential (2). In the last decades, several surgical treatment options have emerged and have already been clinically established (3-6). Autologous or allogeneic osteochondral transplants consist of articular cartilage and subchondral bone and allow the replacement of the entire osteochondral unit. The defects are filled with cylindrical osteochondral grafts that aim to provide a congruent hyaline cartilage covered surface (3,7,8). Disadvantages are the limited amount of available grafts, donor site morbidity (for autologous transplants) and the incongruence of the surface; thereby the application of this method is especially limited for large defects. New approaches in the field of tissue engineering opened up promising possibilities for regenerative osteochondral therapy. The implantation of autologous chondrocytes marked the first cell based biological approach for the treatment of full-thickness cartilage lesions and is now worldwide established with good clinical results even 10 to 20 years after implantation (9,10). However, to date, this technique is not suitable for the treatment of all types of lesions such as deep defects involving the subchondral bone (11). The sandwich-technique combines bone grafting with current approaches in Tissue Engineering (5,6). This combination seems to be able to overcome the limitations seen in osteochondral grafts alone. After autologous bone grafting to the subchondral defect area, a membrane seeded with autologous chondrocytes is sutured above and facilitates to match the topology of the graft with the injured site. Of course, the previous bone reconstruction needs additional surgical time and often even an additional surgery. Moreover, to date, long-term data is missing (12). Tissue Engineering without additional bone grafting aims to restore the complex structure and properties of native articular cartilage by chondrogenic and osteogenic potential of the transplanted cells. However, again, it is usually only the cartilage tissue that is more or less regenerated. Additional osteochondral damage needs a specific further treatment. In order to achieve a regeneration of the multilayered structure of osteochondral defects, three-dimensional tissue engineered products seeded with autologous/allogeneic cells might provide a good regeneration capacity (11). Beside autologous chondrocytes, mesenchymal stem cells (MSC) seem to be an attractive alternative for the development of a full-thickness cartilage tissue. In numerous preclinical in vitro and in vivo studies, mesenchymal stem cells have displayed excellent tissue regeneration potential (13,14). The important advantage of mesenchymal stem cells especially for the treatment of osteochondral defects is that they have the capacity to differentiate in osteocytes as well as chondrocytes. Therefore, they potentially allow a multilayered regeneration of the defect. In recent years, several scaffolds with osteochondral regenerative potential have therefore been developed and evaluated with promising preliminary results (1,15-18). Furthermore, fibrin glue as a cell carrier became one of the preferred techniques in experimental cartilage repair and has already successfully been used in several animal studies (19-21) and even first human trials (22). The following protocol will demonstrate an experimental technique for isolating mesenchymal stem cells from a rabbit's bone marrow, for subsequent proliferation in cell culture and for preparing a standardized in vitro-model for fibrin-cell-clots. Finally, a technique for the implantation of pre-established fibrin-cell-clots into artificial osteochondral defects of the rabbit's knee joint will be described.

Incongruity affecting osteochondral repair by mosaicplasty technique in an animal model

To compare the influence of the different osteochondral incongruity grades on the osteochondral repair by the mosaicplasty technique in a goat model. The acute defects were created in the weight-bearing area of the medial femoral condyle of the goats. Mosaicplasty was done to repair the defects. While implanting the cylindrical osteochondral grafts, different osteochondral sunk, or elevated incongruities were created. The goats were killed 12 weeks after operation to receive gross and histology observation, which was evaluated by the histological grading scale of O'Driscoll et al. The specimens were also taken for transmission electron microscope examination. Two factors analysis of variance and Student-Newman-Kewls test were used to compare the specimen. Minimal steps, which were less than the thickness of cartilage, possess a capacity for remodeling that can correct initial incongruities while preserving hyaline characteristics. However, the step more than the thickness of cartilage could not be repaired satisfactorily. The incongruity could have an influence on the repair by the mosaicplasty technique in a goat model. The limited incongruity could be repaired by a vigorous remodeling process.

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.

Osteochondritis Dissecans of the Knee in Identical Twins: A Report of Two Cases

We report the second case of osteochondritis dissecans (OCD) of the knee in identical twins (bilaterally in one and unilaterally in the other). Fixations with bio-absorbable pins, cylindrical osteochondral graft, and osteochondral mosaicplasty were all successful and bone union was achieved. We considered that genetic factors remain essential even if other factors (particularly repetitive trauma) are mainly responsible for the occurrence of OCD.

The clinical outcomes of mosaicplasty in the treatment of osteochondritis dissecans of the distal humeral capitellum of young athletes

The purpose of this study was to evaluate the clinical outcomes of mosaicplasty in the treatment of osteochondritis dissecans of the distal humeral capitellum. Between 2003 and 2007, 10 patients (6 female and 4 male patients), with a mean age at surgery of 18 years (range, 13 to 27 years), with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The surgical technique involves transplanting small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyle at the level of the patellofemoral joint to the defect of the capitellum. At a mean follow-up of 30 months, all elbows were assessed with the Mayo Elbow Performance Score and a modified functional elbow score (Constant). Postoperative radiographs and control magnetic resonance imaging/computed tomography images showed incorporation of the subchondral cortex in all patients. All but 2 patients were completely pain free after surgery. Of the patients, 8 (80%) had no reduction in range of motion. By use of the Mayo Elbow Performance Score, the injured elbow had a preoperative mean score of 71 points (range, 55 to 85 points) and increased significantly to a mean score of 93.5 points (range, 85 to 100 points) postoperatively (P = .0005, paired t test). The nonoperative elbows had a mean score of 100 points, whereas the operated elbows had a mean score of 93.5 points. The functional elbow score showed a mean difference of 7.5 points between the operated and nonoperative elbows. No infection or neurologic deficit developed after surgery in any case. Autologous osteochondral mosaicplasty for advanced lesions of capitellar osteochondritis dissecans can provide satisfactory clinical and radiographic results.

Autologous Osteochondral Mosaicplasty for Osteochondritis Dissecans of the Elbow in Teenage Athletes

Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans. From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery. Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112° ± 17° preoperatively to 128° ± 12° postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 ± 23 points preoperatively to 191 ± 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient. The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions.

Multiple Osteochondral Autograft Transfer to the Proximal Interphalangeal Joint: Case Report

A 17-year-old boy who played baseball presented with swelling, pain, and crepitation in the right ring finger proximal interphalangeal joint after a remote trauma. Multiple osteochondral defects were identified on opposing articular surfaces. Cylindrical osteochondral grafts of 2.0, 2.5, and 5.0 mm were applied to the defects and congruency was restored. We confirmed vascularity of the grafts by magnetic resonance. The boy returned to full sports activities. No signs of arthritis were seen at 4-year follow-up radiographs.

Autologous Osteochondral Mosaicplasty for Osteochondritis Dissecans of the Elbow in Teenage Athletes

Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans. From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery. Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112 degrees +/- 17 degrees preoperatively to 128 degrees +/- 12 degrees postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 +/- 23 points preoperatively to 191 +/- 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient. The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions.

Sequential Alterations in Magnetic Resonance Imaging Findings After Autologous Osteochondral Mosaicplasty for Young Athletes With Osteochondritis Dissecans of the Humeral Capitellum

Background The goal of osteochondral mosaicplasty (mosaicplasty) against osteochondritis dissecans of the humeral capitellum (capitellar OCD) is to allow patients to return to their sports activities without functional disturbance of the affected elbow. Consequently, the rehabilitation protocol and the interval before returning to sports activities must be established. Although surgeons need this type of data for establishing sequential alterations of grafts in the elbow, no such data have been published. Hypothesis The findings of magnetic resonance imaging (MRI) improve with increasing time after mosaicplasty for capitellar OCD. Study Design Case series; Level of evidence, 4. Methods Ten young male athletes with advanced lesions of capitellar OCD, treated with mosaicplasties, underwent MRI scans at 3, 6, and 12 months, postoperatively. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting them to the capitellar lesion. The MRI findings were semiquantitatively assessed according to the scoring system of Henderson et al (4, normal; 16, no repair). Results At 12 months, all patients returned to their competitive level of sports without any disturbances of the operated elbow. Fluid surrounding the graft was found in all patients at 3 months and 4 patients at 6 months. The grafts were all well seated within the recipient sites, with no MRI evidence of graft loosening at 12 months. The overall MRI scores significantly improved from 3 to 12 months. Conclusion The MRI findings indicate that the graft incorporation to the surrounding tissues occurs around or after 6 months, postoperatively. This finding suggests that rehabilitation precautions be taken for up to 6 months after mosaicplasty for young athletes with capitellar OCD.