Osteochondral Autograft Transplantation Research Articles

Articular Cartilage: Injury Pathways and Treatment Options

Articular cartilage injury and degeneration is a frequent occurrence in synovial joints. Treatment of these articular cartilage lesions are a challenge because this tissue is incapable of quality repair and/or regeneration to its native state. Nonoperative treatments endeavor to control symptoms, and include anti-inflammatory medication, viscosupplementation, bracing, orthotics, and activity modification. Techniques to stimulate the intrinsic repair (fibrocartilage) process include drilling, abrasion, and microfracture of the subchondral bone. Currently, the clinical biologic approaches to treat cartilage defects include autologous chondrocyte implantation, periosteal transfer, and osteochondral autograft or allograft transplantation. Newer strategies employing tissue engineering being studied involve the use of combinations of progenitor cells, bioactive factors, and matrices, and the use of focal synthetic devices. Many new and innovative treatments are being explored in this exciting field. However, there is a paucity of prospective, randomized controlled clinical trials that have compared the various techniques, treatment options, indications and efficacy.

Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Elbow in Juvenile Baseball Players

Background Osteochondral autografts have recently become popular to treat articular cartilage defects, and they are used for unstable osteochondritis dissecans lesions as a means of biological fixation. Purpose To evaluate the clinical results of osteochondral autograft transfer for osteochondritis dissecans of the elbow. Study Design Case series; Level of evidence, 4. Methods Osteochondral autograft transfer was performed on 18 baseball players (mean age, 13.6 years) with osteochondritis dissecans of the elbow. These included 9 lesions that were grade 3 (separated but in situ) and 9 lesions that were grade 4 (displaced fragment with osteochondral defect) based on magnetic resonance imaging. All patients were evaluated with a scoring system, radiographs, and magnetic resonance imaging, with the mean follow-up at 3.5 years. Results In patients with grade 3 lesions, the subjective score was increased, but the objective score did not change. Six of 9 patients returned to their previous sports performance levels. One quit baseball because of academic reasons, 1 changed his position, and 1 changed to softball. In patients with grade 4 lesions, both subjective and objective scores were increased significantly. All but 1 patient returned to their previous sports performance levels. In the 3 grade 4 lesions with a wide osteochondral defect, the irregularity of the articular surface remained on magnetic resonance imaging. Conclusion Osteochondral autograft transplantation is a useful treatment for reattachment of the lesion as well as osteochondral resurfacing of elbow osteochondritis dissecans.

距骨における離断性骨軟骨炎に対する自家骨軟骨移植術の１症例

We present a case of a 13-year-old boy with osteochondritis dissecans of the talus, in whom favorable outcomes were obtained by osteochondral autograft transplantation. He underwent arthroscopic fixation of the osteochondral lesions of the talus using polydioxanone pins, but came our hospital due to nonunion. Since pain in the ankle persisted, plain radiography and magnetic resonance imaging were performed. The results suggested stage 3 osteochondritis dissecans of the talus, according to the four-stage classification of Berndt and Hatty. We performed osteochondral autograft transplantation. At the time of writing this report 12 months postoparatively), the patient had experienced no pain and range of motion was not limited. In addition, radiolucency of the talus was restored.

Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Capitellum in Nonthrowing Athletes

In this report, we present the cases of 3 nonthrowing athletes with osteochondritis dissecans of the capitellum. Preoperatively, they complained of elbow pain during rhythmic gymnastics, table tennis, and basketball, respectively. Magnetic resonance imaging showed a completely separated osteochondral fragment or a full-thickness cartilage defect. All 3 patients were treated with transplantation of an osteochondral autograft harvested from the lateral femoral condyle. They returned fully to their sports activities within 6 months of surgery. The continuity of the cartilage layer between the osteochondral graft and the capitellum was shown on magnetic resonance images taken at 12 months postoperatively. We believe that osteochondral autograft transplantation provides successful results for nonthrowing athletes with end-stage osteochondritis dissecans of the capitellum.

Knee Reconstruction in Syndromes With Congenital Absence of the Anterior Cruciate Ligament

The authors review their experience with four patients with congenital deficiency of the anterior cruciate ligament (ACL) who underwent surgical treatment of symptomatic knee instability at a mean age of 15.8 years (range 14-17 years). Associated syndromes included fibular hemimelia, congenital short femur, and an unspecified skeletal dysplasia. All patients had undergone multiple previous realignment and leg lengthening procedures and were skeletally mature at the time of the reconstruction. All four patients underwent ACL reconstruction, and one patient underwent concomitant posterolateral corner reconstruction. One patient required an osteochondral autograft transplant procedure in addition to ACL reconstruction. Hypertrophy of the meniscofemoral ligament of Humphrey was a consistent anatomic finding at surgery. The patients were followed for a mean of 38 months (range 26-58 months) after the reconstruction. The mean preoperative Lysholm II score was 38 (range 28-56); the score had improved to a mean of 81 (range 78-93) at the latest follow-up. The authors conclude that reconstructive surgery is a viable option for restoration of knee stability and function in appropriately selected patients with congenital ACL deficiency.

Autologous Osteochondral Grafting (Mosaic Arthroplasty) for Treatment of Subchondral Cystic Lesions in the Equine Stifle and Fetlock Joints

To describe treatment of equine subchondral bone cysts (SBCs) by reconstruction of the articular surface with osteochondral grafts. Case series of horses with SBCs unresponsive to conservative therapy. Eleven horses (1-12 years). SBCs were identified in 4 locations: medial femoral condyle (5 horses), lateral femoral condyle (1), distal epiphysis of the metacarpus (4), or metatarsus (1). Osteochondral autograft transplantation (mosaic arthroplasty) was performed, taking grafts from the abaxial border of the medial femoral trochlea of the unaffected limb. Graft implantation was achieved through a small arthrotomy or by arthroscopy depending on SBC location. All horses improved postoperatively; 10 horses had successful outcomes with radiographic evidence of successful graft incorporation and 7 returned to a previous or higher activity level. On follow-up arthroscopy (5 horses) there was successful reconstitution of a functional gliding surface. One horse had delayed incorporation of a graft because of a technical error but became sound. One horse had recurrence after 4 years of work and soundness. One stallion was used for breeding and light riding because of medial meniscal injuries on the same limb. Implantation of osteochondral grafts should be considered for SBC when conservative management has not improved lameness and there is a risk of further joint injury and degeneration. Mosaic arthroplasty should be considered for treatment of subchondral bone cysts of the femoral condyle and distal articular surface of the metacarpus/tarsus in horses that are refractory to non-surgical management.

Retrograde cartilage transplantation on the proximal and distal tibia

The authors, with experience with more than 400 osteochondral autograft transplantation (OATS) cases since 1996, report a new technique of a retrograde osteochondral autograft transplantation for the treatment of isolated osteochondral lesions of the proximal and the distal tibia started in 1999. We treated 5 patients, 3 who presented with painful traumatic chondral defects in the central weight-bearing portion of the tibial plateau (1 in the medial and 2 in the lateral compartment), and 2 who presented with painful chondral lesions on the distal tibia. An anterior cruciate ligament (ACL) drill guide positioned in the center of the defect was used to accurately prepare the cartilage surface, in one case arthroscopically and in 4 cases through an open incision. A guide-wire was introduced and drilled through the tibia, and a cannulated reamer equal to the diameter of the defect was advanced. An osteochondral cylinder was harvested from the non-weight-bearing zone of the femoral trochlea at the angle that corresponded to the angle on the ACL drill guide. The autograft was inserted in a retrograde fashion from the cortical window into the tibial tunnel to be flush with the articular surface in press-fit technique. The remaining tunnel defect between the cortical window on the tibia and the distal aspect of the autograft was filled with a cancellous bony cylinder and secured with a diagonal bioabsorbable screw. A concomitant varus deformity with the lesion on the medial tibial plateau was corrected in the same surgery using a high tibial osteotomy to relieve stress on the graft. Patients were followed up for 6 to 35 months. A complete healing of the grafts was seen in control magnetic resonance images (MRIs). All patients were satisfied with the surgery. Control arthroscopies showed the osteochondral cylinders well integrated and flush with the articular surface.

Treatment of osteoarthritic cartilage lesions with osteochondral autograft transplantation.

Twenty-two osteochondral autograft transplantations were performed on two types of knees: those with isolated (group 1) and multiple (group 2) degenerative cartilage lesions. At minimum 24-month follow-up, group 1 had significantly better pain relief and function than group 2 based on the Western Ontario and McMaster Universities Osteoarthritis Index and pain scores (10-point visual analog scale). Osteochondral autograft transplantation may be effective in treating knees with isolated degenerative cartilage lesions but appears contraindicated in those with multiple lesions.

Joint Preserving Surgery for Osteonecrosis and Osteochondral Defects after Chemotherapy in Childhood

As a complication of chemotherapy/corticosteroids for the treatment of acute lymphoblastic leukemia (ALL) and other malignancies during childhood, avascular osteonecrosis appears in up to 30 % of the patients. Weight-bearing joints are involved in over 90 % of the cases. Total joint replacement is often necessary to restore function. Yet, endoprostheses in young patients again bare the risk of later complications and the need for several revision surgeries. In this report, joint preserving surgical strategies will be discussed. Three hips and eleven knee joints in 8 patients (4 male, 4 female) were operated on for symptomatic ON and/or osteochondral defects (OCD) after chemotherapy. Four of the patients underwent surgery in more than one joint. The average age at the time of surgery was 18 years (range 14 - 26). The procedures included retrograde drilling (core decompression), bone grafting, implantation of collagen sponges with autologous bone marrow aspirate, osteochondral autograft transplantation and transplantation of periosteal flaps. Two hip joints underwent total joint replacement. Average follow up was 25 months. After an average follow up of 2 years, all patients were satisfied with the functional results after the last follow up with pain free walking for a minimum of 60 minutes. No night pain was reported. One patient complained about intermittent periods of dysaesthesia around the bone harvest area at the iliac crest. The aim of surgery for ON and OCD after chemotherapy should be the reduction of pain and preservation of the joint to bypass the risks of joint replacement in young patients, although total joint replacement may become indicated in endstage degeneration of the involved joint.

Anterior cruciate reconstruction combined with autologous osteochondral transplantation.

The purpose of this prospective study was to evaluate the results of simultaneous anterior cruciate ligament (ACL) reconstruction and osteochondral autograft transplantation performed in patients suffering an anterior instability associated with symptomatic full-thickness cartilage defects. Our clinical report includes the first 21 patients (six women, 15 men) who have been followed up for 32 months or longer. The average patient age was 29 years (range 22-44 years), and mean time from injury to the combined reconstructive surgery was 10 months (range 4-27 months). The cartilage defects had a mean area of 3.5 cm2 (range 2.0-5.0 cm2). All patients were evaluated according to the IKDC, Lysholm and Tegner scoring scales by an independent observer. A visual analogue scale (VAS) reflecting patient pain was evaluated. Assessment using the IKDC knee scoring scale revealed 81% of the patients with a normal or nearly normal knee joint. There was a significant improvement in subjective discomfort, and the KT-1000 arthrometric evaluation showed a reduction of the ventral tibial translation (5.9 to 1.9 mm). All but two patients had returned to full activities without restriction and were asymptomatic. The results of this study suggest that symptomatic full-thickness articular cartilage defects associated with ACL instability can be effectively treated by performing ACL reconstruction and osteochondral autologous grafts in one procedure. However, only the years which follow will show the long-term outcome of the patients.

Paper #117 Osteochondral autograft transplantation for traumatic and degenerative lesions of the ankle joint

Paper #117 Osteochondral autograft transplantation for traumatic and degenerative lesions of the ankle joint

Knee instability and varus malangulation - Simultaneous cruciate ligament reconstruction and osteotomy (Indication, planning and operative technique, results)

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malangulated knees. We present the indication, planning of the osteotomy as well as the operative technique and the results of our patients with simultaneous osteotomy and cruciate ligament reconstruction. From 4/96 until 12/00 58 patients ( 33 years) received simultaneous osteotomy (r = 57 correcting valgus, r = 1 varus malalignement) and cruciate ligament plasty (e = 49 ACL, n = 7 PCL, n = 2 ACL & PCL which routinely was performed in the arthroscopic technique after completion of the osteotomy (closed-wedge technique). Average correction angle of the osteotomy was 7 (4 - 10) degrees with a mean malalignement of 5 (0 - 10) degrees. 13 patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), 2 patients received an implanted Collagen Meniscus (CMI) at the same time. Preoperatively the Lysholm score was 66 (35 - 81) points and increased to 81 (74 - 95), 87 (79 - 99) and 93 (88 - 99) points at 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in 4 patients. Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost effective therapy delaying the progression of osteoarthritis and minimising clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and return of these patients to the activities of daily living and sports.

Axis deviation, cartilage damage and cruciate ligament rupture--concomitant interventions in replacement of the anterior cruciate ligament

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability and varus malalignment. We present the indications, operative technique, and results for the combined operation of high tibial osteotomy and cruciate ligament reconstruction. From April 1996 until December 2000, 58 patients (average age: 33 years) underwent simultaneous osteotomy (57 correcting valgus, 1 valgus malalignment) and cruciate ligament reconstruction (49 ACL, 7 PCL, 2 ACL & PCL) which was routinely performed with an arthroscopic technique after completion of the osteotomy (closed wedge technique). Average correction angle of the osteotomy was 7 degrees (4-10 degrees) with a mean malalignment of 5 degrees (0-10 degrees). Thirteen patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), and two patients were implanted with a collagen meniscus (CMI) at the same time. Preoperatively the Lysholm score was 66 (35-81) points and increased to 81 (74-95), 87 (79-99), and 93 (88-99) points 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in four patients. Unstable knees with varus malalignment can be sufficiently treated by osteotomy and cruciate ligament reconstruction at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost-effective therapy delaying the progression of osteoarthritis and minimizing clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and the return of these patients to the activities of daily living and sports.

Surgical therapeutic possibilities of cartilage damage

Therapy of cartilage damage is a frequent problem, especially in the young and active patient. For the treatment of a cartilage damage we have to consider the size of the defect, age and weight of the patient, meniscal tears, ligament instabilities and varus-/valgus-malalignment. Lavage, shaving and debridement are only sufficient for a short time and have no long term effect. Abrasio and drilling could be useful in eldery people. Microfracturing seems to be an effective alternative for small defects. The restoration of the cartilage surface with the use of autologous chondrocyte transplantation, osteochondral autograft transplantation and posterior condyle transfer seems to be an adequate treatment for younger patients.

Arthroscopic osteochondral autograft transplantation for chondral lesion of the tibial plateau of the knee

Arthroscopic osteochondral autograft transplantation is often used to treat chondral/osteochondral lesions of the femoral condyle of the knee. However, arthroscopic autologous osteochondral grafting to the tibial plateau has not been reported. We report the surgical technique and the clinical course of a patient who underwent engraftment by this method. A 26-year-old man developed symptoms of pain and catching in his knee. Arthroscopy revealed a deep chondral lesion, 10 × 15 mm in size, down to the subchondral bone on the posterocentral area of the lateral tibial plateau. The injured cartilage was debrided using a curette and an abrader until normal healthy cartilage bordered the debrided defect. An osteochondral plug, 10 mm in diameter and 20 mm long, the chondral surface of which was orientated 25° obliquely, was harvested from the most peripheral and proximal part of the lateral patellar groove. A bony hole was created in the center of the defect through the tibia using a core reamer. The osteochondral plug was inserted from the tibial window through the bony hole. To enhance the stability of the osteochondral fragment, bioactive ceramic fillers were used to fill the space below the plug. A second-look arthroscopy 10 months after surgery showed that the grafted osteochondral plug was well adapted and integrated into the surrounding cartilage on the lateral tibial plateau.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 653–659

Osteochondral autograft for the treatment of focal cartilage lesions

Osteochondral autograft transplantation is an acceptable treatment option for symptomatic chondral lesions of the femur. Animal and human studies have showed cartilage viability at 2 years transplantation. Clinical evidence shows an overall 85% average rate of efficacy in diminishing the pain and swelling associated with chondral lesions. Clinical results are best optimized by using this technique for small focal lesions ( 2 ).

Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse

An 11-year-old, Hungarian half-bred stallion was presented with a history of mixed left hindlimb lameness of 6 months duration. Subchondral bone cyst of the medial femoral condyle and injury of the medial meniscus were diagnosed. Osteochondral autograft transplantation (mosaic arthroplasty) was performed, taking grafts from the less weight-bearing medial border of the medial femoral trochlea of the affected limb, and transplanting them into the cyst during arthroscopy. The lameness was evaluated prior to and one year after the operation with a motion analysis system during treadmill exercise. Considerable improvement of the lameness and the clinical signs as well as successful transplantation of the grafts, and a new hard joint cartilage surface of the medial femoral condyle could be detected during follow-up arthroscopy. Osteochondral autograft transplantation seems to bee a possible alternative for treating subchondral cystic lesions of the medial femoral condyle in horses. A new technique for the surgical treatment of a subchondral cystic lesion of the medial femoral condyle in the horse is described.

Osteochondral autologous graft transfer

It is reasonable to assume that the closer cartilage repair comes to restoring hyaline cartilage, the more durable therepair tissue. However, the choice of surgical techniques that can restore and maintain hyaline cartilage is very limited. At present, osteochondral autograft transplantation seems to be the only surgical technique that can simultaneously restore the height and shape of the articulating surface in osteochondral defects, with composite autologous material that contains all the necessary ingredients: hyaline articular cartilage, intact tidemark, and a firm carrier in the form of its own subchondral bone. However, like many orthopedic procedures that require the use of autologous tissues, this is a “rob Peter to pay Paul” situation. Consequently, the main limitation of this technique is the availability of autologous grafts. The size and depth of the defects are other significant limiting factors. The dead spaces between circular grafts, the integration of donor and recipient hyaline cartilage, different positions, and the thickness and mechanical properties of donor and recipient hyaline artilage are additional clinical concerns over the long term.

Autologous osteo-chondral grafts in the management of articular cartilage lesions

It is well known that the capacity of articular cartilage for repair is limited. There have been many attempts to address this problem. However, treatment options are limited and the long-term outcome is uncertain. This article will focus on the osteochondral autograft transplantation (OAT), which is currently the only surgical cartilage repair technique that provides and retains proper hyaline articular cartilage. Osteochondral autograft transplants have been associated with a good rate of success, but further long-term follow-up and biomechanical evaluation are essential. size and depth of osteochondral defects, availability of donor autologous grafts, potential for damaging donor sites, the dead spaces between circular grafts and integration of donor and recipient hyaline cartilage.

The utilisation of osteochondral autologous grafts in the treatment of articular cartilage lesions

It is well known that the capacity of articular cartilage for repair is limited. There have been many attempts to address this problem. However, treatment options are limited and the long-term outcome is uncertain. This article will focus on the osteochondral autograft transplantation (OAT), which is currently the only surgical cartilage repair technique that provides and retains proper hyaline articular cartilage. Osteochondral autograft transplants have been associated with a good rate of success, but further long-term follow-up and biomechanical evaluation are essential. Limitations: size and depth of osteochondral defects, availability of donor autologous grafts, potential for damaging donor sites, the dead spaces between circular grafts and integration of donor and recipient hyaline cartilage.