31May 2016

THE OUTCOME OF OSTEOCHONDRAL AUTOGRAFT TRANSFER FOR TREATMENT OF FOCAL ARTICULAR CARTILAGE DEFECTS OF THE FEMORAL CONDYLES.

  • Department of Orthopedics, Faculty of Medicine, Zagazig University, Egypt.
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Background: Repair of full thickness defects of articular cartilage in the knee is a challenging problem but important to prevent progression to early osteoarthritis. The purpose of this study was to evaluate the outcome of osteochondral autograft transfer for treatment of focal articular cartilage defects of the femoral condyles. Patients and Methods: A prospective study was conducted at our institution, between 2012 and 2015, on osteochondral autograft transplantation (OATS technique) for treatment of symptomatic focal chondral and osteochondral defects of the femoral condyles in 15 knees of 15 patients (who were available for follow-up examination). The mean age of the patients was 29 ? 7.2 years (range: 16 ? 41 ys.). The defects was in the weight-bearing part of the medial (n=11) or lateral femoral condyle (n=4). The mean size of the defects was 2.1 ? 0.8 cm? (range: 1 ? 3.5 cm?). Aetiologically, 10 cases were posttraumatic and five cases were due to osteochondritis dissecans. Nine patients had a grade III / IV cartilage lesion, according to the Outerbridge classification system and six patients had osteochondral defects. The exclusion criteria were: age > 45 years, body mass index >30, un-reliable patients, lesions >3.5 cm?, reciprocal lesions, uncorrected malalignment, uncorrected ligamentous instability, previous total meniscectomy, infection, tumor, advanced osteoarthritis or inflammatory arthritis. Four cases were performed arthroscopically, while 11 cases through a mini-arthrotomy. Results: The mean follow-up period was 12 ? 4 months (range: 10 - 18 months). The results were evaluated by history taking, physical examination, patient satisfaction, Lysholm score, radiography and MRI in all cases and a second-look arthroscopy, only in two patients. The mean total Lysholm Score improved from a preoperative value of 49.5?14.2 points to a value of 85.4?11.5 points at the final follow-up. Excellent and good results were achieved in 12 cases (80%) and fair result in 3 cases (20%), but no poor results. Postoperative complications included: (a) mild?moderate joint effusion in two patients (13.3%) (b) superficial wound infection in one patient (6.6℅) with open procedure, but no deep infection (c) hemarthrosis in three cases (20℅) (d) knee stiffness in two cases (13.3℅) (e) temporary donor site knee pain in four cases (26.7℅). There was no significant correlation of the results with the underlying diagnoses [posttraumatic or osteochondritis dessicans] or the used method [mini-arthrotomy or arthroscopy]. Conclusions: The OATS-technique is an effective and relatively safe treatment of focal chondral and osteochondral defects of the femoral condyles. It achieves a high good to excellent results, with relatively minor complications. It is a low-cost; one-step operation; with low morbidity and independent on laboratory. However, it is not suitable for lesions >4-5cm?. The associated meniscal or ligamentous injuries and malalignment should be corrected first in a separate session or concomitantly with OATS.

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[Mohamed Othman, Mohamed Abd-Alfattah and Ahmed El-Malt. (2016); THE OUTCOME OF OSTEOCHONDRAL AUTOGRAFT TRANSFER FOR TREATMENT OF FOCAL ARTICULAR CARTILAGE DEFECTS OF THE FEMORAL CONDYLES. Int. J. of Adv. Res. 4 (May). 1600-1611] (ISSN 2320-5407). www.journalijar.com

Mohamed Othman
Department of Orthopedics, Faculty of Medicine, Zagazig University, Egypt

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