Arthroscopic autologous osteochondral grafting effective for knee cartilage lesions

Tuesday, 30 November 1999 00:00 |

Arthroscopic transplantation of autologous osteochondral grafts is a 'valid solution' for repairing small cartilage defects in the knee, according to a report in The American Journal of Sports Medicine.

Osteochondral autograft transplantation, with underlying bone, aims to capitalize on bone-to-bone healing because damaged cartilaginous tissue has limited potential to heal completely with surrounding cartilage, the authors explain.

Dr. Maurilio Marcacci and colleagues from the Rizzoli Orthopedic Institute, Bologna, Italy evaluated medium- to long-term clinical and radiographic results of autologous osteochondral transplantation in grade III to grade IV articular cartilage lesions less than 2.5 square centimeters in area in 30 patients.

More than three quarters of the operated knees were normal or nearly normal (as determined by International Knee Documentation Committee (IKDC) objective scores) at two- and seven-year follow-up, the authors report, showing significant improvement from prior to surgery to both follow-up evaluations.

At the two-year follow-up, 22 patients had returned to sports at the same level and four at a lower level, the authors report, whereas only four were not able to go back to sports. By seven years, seven engaged in sports at the same level, 14 at a lower level, and nine not at all.

Patients with a smaller number of osteochondral plugs implanted during arthroscopic surgery and those with smaller lesions experienced better outcomes at two- and seven-year follow-up, the researchers note.

By MRI evaluation, complete filling of the cartilage defect was maintained at seven years in 62.5 per cent of the patients. Three quarters of the cases showed complete integration of the grafted cartilage, and 95.9 per cent of patients had complete bone integration.

"The results of this technique at medium- to long-term follow-up are encouraging," Dr. Marcacci and associates conclude. "This arthroscopic one-step surgery appears to be a valid solution for treatment of small, grade III to IV cartilage defects.