Osteochondral Cartilage Transplantation in large Osteochondral defects of the Knee or the Ankle - an alternative Treatment to Arthroplasty? - Two-years follow up of 98 patients.

Objectives One major topic in orthopedics is cartilage repair. Autologous osteochondral transplantation (AOT) is a well-known and used Procedure for large cartilage defect repair. The reconstruction of a whole joint condyle remains challenging.

In literature, both positive and concerning reports are found for AOT.

One question of joint reconstruction is, how an alignment of the subchondral bone can be achieved between more than one cylindrical graft, necessary for the reconstruction of a complete condyle of the knee or the dome of the talus. Another concern is where those grafts can be gathered? Regarding donor-site morbidity, the value of reconstruction of donor-sites is often underestimated.

We evaluated results of transplanted patients up to two years postoperatively. In all cases donor side had been reconstructed as well.

Methods Between 2009 and 2014 fifty patients (age 14-74) with large osteochondral defects received knee reconstructions. 8 patients suffered from OD Bruns III-IV, 42 patients (age 25-74) showed chondral defects (ICRS III-IV). Chondromalacia and rheumatoid diseases were excluded.

Femoral condyles were reconstructed 8 times with single-cylinders, 19 times with double-cylinders, 16 times with a triple-cylinder-chain and once with 4 overlapping cylinders. 6 patello-femoral joints were reconstructed.

48 patients received reconstructions of the ankle, 7 had a defect of the lateral talus, 41 of the medial talus. 7 received a single transplant, 40 a double transplant and 2 a triple-cylinder chain.

Surgery was performed according to Draenert et al by autologous grafts of the ipsilateral patellar groove in all cases. Press-fit osteochondral plugs of the iliac crest covered with musculoskeletal fibres were used to restore donor defects.

Clinical evaluation pre- and postoperatively for 2 years consisted of pain evaluation (Visual Analog Scale (VAS)), American Orthopedic Ankle score (AOAS) or/and Tegner-Lysom score (TLS), Modified Cincinnati Score (MCS) and Knee Society score (KSS).

Results and Conclusion Based on VAS, TLS, KSS and MCS, the Knee - and ankle -patient groups presented a highly significant improvement (p =.001, Student T-Test) for all four scores. Knee: VAS (preoperative 5,94, 2y postoperative 0,57); TLS (58,39 > 95,29); KSS (67,58 > 95,33); MCS (55,55 > 94,21) Ankle: (VAS 6,39 > 0,34; AOAS 59,6 > 97,7). There was no donoside morbidity. Intergroup analysis for singe, double and triple cylinder reconstruction itself showed significant improvement.

Conclusion: Good-to excellent postoperative results can be achieved in reconstruction of large osteochondral defects by using a precise operating technique with wet cooled diamond molding cutters. Careful reconstruction of the donor-site may contribute significant to the positive outcomes.

Stichwörter Osteochondral Transplantation, Ankle, Knee, Knorpel

Publication History

Article published online:
15 October 2020