J Korean Orthop Assoc.  2009 Jun;44(3):301-310. 10.4055/jkoa.2009.44.3.301.

Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint

• Seo SS
• Kim CW
• Ha DJ
• Choi JS
• Kim HJ
• Lee CR

• KMID: 2186338
• DOI: http://doi.org/10.4055/jkoa.2009.44.3.301

Abstract

PURPOSE: We wanted to evaluate the outcomes of an autologous osteochondral graft (Mosaicplasty) for treating chondral defects of the femoral condyle and We assessed the factors affecting the clinical results.
MATERIALS AND METHODS
This study enrolled 18 patients (19 cases) who underwent an autogenous osteochondral graft to treat a osteochondral defect in the femoral condyle from July 2000 to June 2006. The average age was 26.2 years old (age range: 16-48 years old). Among the patients, 17 cases were men. In 14 cases, the osteochondral defects were localized in the medial femoral condyle and only 5 cases showed a defect in the lateral femoral condyle. The average size of the osteochondral defects was 4.2 cm2 (1-13 cm2). The Lysholm knee scoring scale and the Tegner's activity score were applied for clinical evaluation. Further, we carried out simple X-ray for all the cases and we performed MRI in 5 cases for the radiological evaluation. Tthe factors affecting the clinical results were also analyzed and the complications were evaluated.
RESULTS
The average follow-up period was 22 months (range: 6-55 months). Eighten out of 19 cases (94.7%) were able to return to ordinary life. The Lysholm knee scoring scale and the Tegner's activity score indicated much better clinical results for small lesions and for young patients. For the radiological results, all the cases displayed a decrease in the size of radiolucent zones on the follow up X-ray. Among the 5 cases for which an MRI was performed, graft unions were observed in 3 cases, but 2 cases displayed continuous peri-graft edema. Any other complications involving the donor and recipient site were not observed.
CONCLUSION
We conclude that autogenous osteochondral grafting is useful for specific patients depending on the size of the lesion and the patient's age. It is a valuable treatment option for osteochondral defects in the knee joint.

Keyword

Femoral condyle; Osteochondral defect; Autogenous osteochondral graft

MeSH Terms

Edema
Follow-Up Studies
Humans
Knee
Knee Joint
Male
Tissue Donors
Transplants

Figure

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  Fig. 1 (A) The overall Lysholm knee scoring scale was increased from 61 in preoperation to 83 in postoperation. (B) Also, Tegner's activity score was improved from 2.4 to 4.9.

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  Fig. 2 These photos are preoperative radiographs (A, B) and MR images (C, D) of 22 years old patient with a post traumatic osteochondral defect of the medial condyle and intraoperative finding (E) during operation. Preoperative Lysholm knee scoring scale and Tegner's activity score were 59 and 3, respectively. Reconstruction of a joint line is visible in postoperative MR image (F, G) taken 25 months after surgery. Follow up Lysholm knee scoring scale and Tegner's activity score were improved to 76 and 4, respectively.

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  Fig. 3 (A-C) These photos are preoperative radiographs of 17 years old patient with osteochondritis dissecans of the medial condyle in both femur ((B): Left, (C): Right). (D, E) Large amount of persistent perigraft edema-like signal change is visible in postoperative MRI scan taken 12 months after mosaicplasty. Follow up Lysholm knee scoring scale and Tegner's activity score were not significantly changed, comparing with preoperatives ((D): Left, (E): Right).

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  Fig. 4 These photos are preoperative radiographs (A, B) and postoperative radiographs (C, D) taken 12 months after mosaicplasty of 43 years old patient with osteonecrosis of the medial condyle in right femur. Preoperative Lysholm knee scoring scale and Tegner's activity score were 63 and 2, respectively. Follow up Lysholm knee scoring scale and Tegner's activity score were improved to 78 and 4, respectively.

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  Fig. 5 These photos show intraoperative finding of 30 years old patient with an osteochondritis dissecans of the lateral condyle in left femur. The size of osteochondral defect was 13 cm2 (A), and 13 plugs were in use (B).

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