Cylindrical Osteochondral Grafts Research Articles

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.

Osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee: Results at 5 to 9 years

We evaluated short- and medium-term results of the treatment of articular cartilage defects of the knee with autogenous cylindrical osteochondral grafts (mosaicplasty) in 69 patients (median age 33 years) with symptomatic articular cartilage defects. Data of Lysholm score and visual analogue scale (VAS) of pain (0 = no pain; 100 = worst possible pain) were collected before the surgery, at 12 months postoperatively and 5 to 9 (median 7) years after the surgery. At the last follow-up the patients were also asked to state their degree of satisfaction with the outcome on a VAS (0 = not at all satisfied; 100 = completely satisfied), and to answer if they would have undergone the surgery again if necessary (yes or no). The mean Lysholm score and VAS of pain improved from 48 and 62, respectively, at the time of surgery to 81 and 24, respectively, at the 12-months follow-up ( p < 0.001 for both comparisons). From 12 months postoperatively, the Lysholm score and VAS of pain deteriorated to 68 and 32, respectively at the 5- to 9-year follow-up ( p < 0.001 and p = 0.018, respectively). The mean degree of satisfaction with the outcome was 70 (SD 28), and 61 patients (88%) stated that they would have undergone the surgery again. In conclusion, the mosaicplasty leads to improvement of symptoms and function at short- and medium-term follow-up. A deterioration of the results is observed from 12 months postoperatively to 5–9 years postoperatively.

Transduction of Anti-Cell Death Protein FNK Suppresses Graft Degeneration After Autologous Cylindrical Osteochondral Transplantation

This study shows that artificial super antiapoptotic FNK protein fused with a protein transduction domain (PTD-FNK) maintains the quality of osteochondral transplant by preventing chondrocyte death. Cylindrical osteochondral grafts were obtained from enhanced green fluorescent protein (EGFP)-expressing transgenic rats, in which living chondrocytes express green fluorescence, and submerged into medium containing PTD-FNK, followed by transplantation into cartilage defects of wild-type rats by impact insertion simulating autologous transplantation. The tissues were histologically evaluated by hematoxylin-eosin and Safranin-O staining. At 1 week, chondrocyte alignment was normal in the PTD-FNK treatment group, whereas all grafts without PTD-FNK treatment showed mixed cluster cell distribution. At 4 weeks, all grafts with PTD-FNK treatment showed almost normal matrix, whereas two grafts without PTD-FNK treatment showed fibrocartilage. Notably, all grafts with PTD-FNK retained high intensity of Safranin-O staining, but all grafts without PTD-FNK largely lost Safranin-O staining. PTD-FNK significantly suppressed a decrease in the survival rate and the density of EGFP-positive cells at 1 and 2 weeks, and this tendency continued at 4 weeks. The results of terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP)-nick end-labeling staining showed that PTD-FNK inhibited cell death, indicating that PTD-FNK protects chondrocyte death and suppresses graft degeneration.

Donor Site Evaluation after Autologous Osteochondral Mosaicplasty for Cartilaginous Lesions of the Elbow Joint

Background One significant disadvantage of autologous osteochondral mosaicplasty (mosaicplasty) is the harvesting of osteochondral grafts from the normal articular area of the knee joint. However, the effect of harvesting grafts on knee function remains unclear. Purpose To clarify the functional effects on the donor knee of harvesting osteochondral grafts and to perform magnetic resonance imaging evaluation of donor site repair after mosaicplasty for capitellar osteochondritis dissecans in young athletes. Study Design Case series; Level of evidence, 4. Methods Eleven male competitive athletes with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The surgical technique involves 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 osteochondral defects in the capitellum. Assessment at a mean follow-up of 26 months included local findings of the donor knees, a Lysholm knee scoring scale, International Knee Documentation Committee standard evaluation form, and magnetic resonance imaging evaluation. Results All patients returned to a competitive level of their previous sports without any donor site disturbances. Based on the Lysholm knee score and International Knee Documentation Committee evaluation form, all knees were graded as excellent and normal, respectively. The magnetic resonance imaging showed 50% to 100% defect fill in 6 of 9 patients and normal or nearly normal signals in 4 patients at the donor sites. Conclusion No adverse effects of osteochondral graft harvest on donor knee function were found after mosaicplasty for capitellar osteochondritis dissecans in young athletes. However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue.

Osteochondral Transplantation to Treat Osteochondral Lesions in the Elbow

Effective treatment of osteochondral lesions in the elbow remains challenging. Arthroscopic débridement and microfracture or retrograde drilling techniques are often insufficient and provide only temporary symptomatic relief. The purpose of this study was to evaluate the treatment of these lesions with osteochondral autografts. From 1999 to 2002, seven patients with osteochondral lesions of the capitellum humeri (five patients), trochlea (one patient), or radial head (one patient) were treated with cylindrical osteochondral grafts, which were harvested from the non-weight-bearing area of the proximal aspect of the lateral femoral condyle. The patients (three female and four male patients with an average age of seventeen years) were evaluated preoperatively and postoperatively, with an average follow-up of fifty-nine months. The Broberg and Morrey score was chosen for functional evaluation of the elbow (with regard to motion, pain, strength, activities of daily living, and stability), and the American Shoulder and Elbow Surgeons score was used for the analysis of pain. All patients had imaging studies done preoperatively to evaluate the defect and postoperatively to assess the ingrowth and viability of the graft. The ipsilateral knee was examined for donor-site morbidity. The Broberg and Morrey score improved from a mean (and standard deviation) of 76.3 +/- 13.2 preoperatively to 97.6 +/- 2.7 postoperatively, and pain scores were significantly reduced (p < 0.05). The mean elbow extension lag of 4.7 degrees +/- 5.8 degrees was reduced to 0 degrees postoperatively. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.9 degrees +/- 13.8 degrees . At the time of the final follow-up, flexion was free and was equal bilaterally in all patients. None of the plain radiographs made at the time of follow-up showed any degenerative changes or signs of osteoarthritis. The postoperative magnetic resonance imaging scans showed graft viability and a congruent chondral surface in all seven patients. No donor-site morbidity was noted at one year postoperatively. The osteochondral autograft procedure described in the present study provides the opportunity to retain viable hyaline cartilage for the repair of osteochondral lesions in the elbow while restoring joint congruity and function and perhaps reducing the risk of osteoarthritis. These medium-term results suggest that the risks of a two-joint procedure are modest and justifiable. In addition, the described technique provides an option for revision surgery after the failure of other surgical procedures.

Osteochondral Transplantation to Treat Osteochondral Lesions in the Elbow

Background: Effective treatment of osteochondral lesions in the elbow remains challenging. Arthroscopic débridement and microfracture or retrograde drilling techniques are often insufficient and provide only temporary symptomatic relief. The purpose of this study was to evaluate the treatment of these lesions with osteochondral autografts. Methods: From 1999 to 2002, seven patients with osteochondral lesions of the capitellum humeri (five patients), trochlea (one patient), or radial head (one patient) were treated with cylindrical osteochondral grafts, which were harvested from the non-weight-bearing area of the proximal aspect of the lateral femoral condyle. The patients (three female and four male patients with an average age of seventeen years) were evaluated preoperatively and postoperatively, with an average follow-up of fifty-nine months. The Broberg and Morrey score was chosen for functional evaluation of the elbow (with regard to motion, pain, strength, activities of daily living, and stability), and the American Shoulder and Elbow Surgeons score was used for the analysis of pain. All patients had imaging studies done preoperatively to evaluate the defect and postoperatively to assess the ingrowth and viability of the graft. The ipsilateral knee was examined for donor-site morbidity. Results: The Broberg and Morrey score improved from a mean (and standard deviation) of 76.3 ± 13.2 preoperatively to 97.6 ± 2.7 postoperatively, and pain scores were significantly reduced (p < 0.05). The mean elbow extension lag of 4.7° ± 5.8° was reduced to 0° postoperatively. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.9° ± 13.8°. At the time of the final follow-up, flexion was free and was equal bilaterally in all patients. None of the plain radiographs made at the time of follow-up showed any degenerative changes or signs of osteoarthritis. The postoperative magnetic resonance imaging scans showed graft viability and a congruent chondral surface in all seven patients. No donor-site morbidity was noted at one year postoperatively. Conclusions: The osteochondral autograft procedure described in the present study provides the opportunity to retain viable hyaline cartilage for the repair of osteochondral lesions in the elbow while restoring joint congruity and function and perhaps reducing the risk of osteoarthritis. These medium-term results suggest that the risks of a two-joint procedure are modest and justifiable. In addition, the described technique provides an option for revision surgery after the failure of other surgical procedures. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Effect of Impact on Chondrocyte Viability During Insertion of Human Osteochondral Grafts

Osteochondral grafts, used to treat chondral and osteochondral defects, require high insertional forces that may affect the viability of chondrocytes in the graft. The objectives of this study were to (1) measure the loading impact during insertion of osteochondral grafts, (2) evaluate the effect of insertional loading on chondrocyte viability, and (3) assess this effect on chondrocyte apoptosis and activation of caspase-3. The distal parts of twelve fresh femora from six adult human cadavers were harvested within seventy-two hours after the death of the donor. From each femur, four 15-mm-diameter cylindrical osteochondral grafts were isolated; two of these grafts (a total of twenty-four grafts in the study) were transplanted with standard impact insertion into recipient sockets in the other condyle of the ipsilateral femur. The other two grafts served as unloaded controls. Loads were measured during the insertion of ten of the twenty-four transplanted grafts. Full-thickness cartilage disks were then removed from the grafts, incubated for up to forty-eight hours, and analyzed for cell viability, TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling)-positive reactivity, and caspase-3 activation, each as a function of the depth from the articular surface. The insertion of an osteochondral graft was characterized, on the average (and standard deviation), by 10 +/- 4 impacts, each generating 2.4 +/- 0.9 kN of load and 13.3 +/- 4.9 MPa of stress for a duration of 0.57 +/- 0.13 ms with a 0.62 +/- 0.25 N.s impulse. Impact insertion increased cell death in the superficial 500 mum to 21% at one hour (p < 0.001) and 47% at forty-eight hours (p < 0.001) and also increased cell death in deeper layers at forty-eight hours. Some cell death was due to apoptosis, as indicated by an increase in caspase-3 activation at eight hours (p < 0.01) and TUNEL-positive cells at forty-eight hours (p < 0.05) in the superficial 500 mum of impacted cartilage. Impact insertion of osteochondral grafts generates damaging loads that cause chondrocyte death, particularly in the superficial zone, mainly as a result of apoptosis mediated by the activation of caspases. Chondrocyte death that occurs during impact insertion of osteochondral grafts may lead to compromised function. Understanding the mechanisms and consequences of such impact loading may provide insights into potential therapeutic interventions, or lead to changes in the insertion technique, to decrease the cell injury associated with impact loading.

Autologous Osteochondral Mosaicplasty for Capitellar Osteochondritis Dissecans in Teenaged Patients

Background Autologous osteochondral mosaicplasty is a new technique to provide hyaline repair for articular defects. Although recent studies have reported the successful treatment of articular defects in the knee and ankle joints with this surgical procedure, little attention has been given to the surgical efficacy of mosaicplasty in the treatment of osteochondritis dissecans of the humeral capitellum. Purpose To clarify the clinical outcomes of mosaicplasty for teenaged patients with advanced lesions of capitellar osteochondritis dissecans. Study Design Case series; Level of evidence, 4. Methods Eight teenaged patients with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. All patients were baseball players who were affected on the right side, which was also their throwing side. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyles and transplanting them to prepared osteochondral defects. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically. Results Seven of the 8 patients were free from elbow pain, and the remaining patient had mild pain occasionally. The mean clinical score described by Timmerman and Andrews (a maximum of 200 points) significantly improved from 140 points to 183 points postoperatively. All patients except one had excellent or good clinical results. Radiographically, the graft incorporation and a normal contour of the subchondral cortex were found in all patients. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared and the signal intensity returned to normal. Six of the 8 patients, including all 3 pitchers, returned to competitive-level baseball. Conclusion Mosaicplasty for advanced lesions of capitellar osteochondritis dissecans in teenaged baseball players can provide satisfactory clinical and radiographic results.

Impact loading of articular cartilage during transplantation of osteochondral autograft

Surgical reconstruction of articular surfaces by transplantation of osteochondral autografts has shown considerable promise in the treatment of focal articular lesions. During mosaicplasty, each cylindrical osteochondral graft is centred over the recipient hole and delivered by impacting the articular surface. Impact loading of articular cartilage has been associated with structural damage, loss of the viability of chondrocytes and subsequent degeneration of the articular cartilage. We have examined the relationship between single-impact loading and chondrocyte death for the specific confined-compression boundary conditions of mosaicplasty and the effect of repetitive impact loading which occurs during implantation of the graft on the resulting viability of the chondrocytes. Fresh bovine and porcine femoral condyles were used in this experiment. The percentage of chondrocyte death was found to vary logarithmically with single-impact energy and was predicted more strongly by the mean force of the impact rather than by the number of impacts required during placement of the graft. The significance of these results in regard to the surgical technique and design features of instruments for osteochondral transplantation is discussed.

Surgical fixation of massive osteochondritis dissecans lesion using cylindrical osteochondral plugs

The prognosis of osteochondritis dissecans (OCD) depends on the age of manifestation and the size of the lesion. Before epiphyseal closure, OCD usually responds well to the restriction of the patient’s sporting activities. Surgical intervention is not always necessary. However, if the disease manifests after epiphyseal closure, it often needs surgical treatment because the lesion is usually found at an advanced stage (International Cartilage Repair Society [ICR] OCD II or more). Furthermore, if a massive lesion develops to separation (ICR OCD II or III) or displaced loose bodies (ICR OCD IV), despite restriction of sporting activities, the prognosis is poor. This report discusses 2 cases of OCD. One patient had a massive stage ICR I lesion, although the disease was found before epiphyseal closure. In the other patient, a 22-year-old man, a large separated fragment (ICR OCD IV) was found after epiphyseal closure. The separated surfaces of the fragment and the mother bed had become sclerotic. Cylindrical osteochondral grafts using jigs for Mosaicplasty (Smith & Nephew, Andover, MA) were performed on the 2 patients, both of whom made successful recoveries. These cases suggest that cylindrical osteochondral grafting is a useful procedure for difficult cases of large lesion size or late manifestation.

Surgical fixation of massive osteochondritis dissecans lesion using cylindrical osteochondral plugs

Abstract The prognosis of osteochondritis dissecans (OCD) depends on the age of manifestation and the size of the lesion. Before epiphyseal closure, OCD usually responds well to the restriction of the patient's sporting activities. Surgical intervention is not always necessary. However, if the disease manifests after epiphyseal closure, it often needs surgical treatment because the lesion is usually found at an advanced stage (International Cartilage Repair Society [ICR] OCD II or more). Furthermore, if a massive lesion develops to separation (ICR OCD II or III) or displaced loose bodies (ICR OCD IV), despite restriction of sporting activities, the prognosis is poor. This report discusses 2 cases of OCD. One patient had a massive stage ICR I lesion, although the disease was found before epiphyseal closure. In the other patient, a 22-year-old man, a large separated fragment (ICR OCD IV) was found after epiphyseal closure. The separated surfaces of the fragment and the mother bed had become sclerotic. Cylindrical osteochondral grafts using jigs for Mosaicplasty (Smith & Nephew, Andover, MA) were performed on the 2 patients, both of whom made successful recoveries. These cases suggest that cylindrical osteochondral grafting is a useful procedure for difficult cases of large lesion size or late manifestation.