J Korean Orthop Assoc.  2009 Jun;44(3):320-328. 10.4055/jkoa.2009.44.3.320.

A Comparison of Clinical Outcomes after Osteochondral Autologous Transplantation & Arthroscopic Microfracture Surgery for Treating of Osteochondral Lesions of the Knee

• Lee DC
• Sohn OJ
• Sung MC

• KMID: 2186340
• DOI: http://doi.org/10.4055/jkoa.2009.44.3.320

Abstract

PURPOSE: We wanted to compare the clinical outcomes after osteochondral autologous transplantation (OAT) and arthroscopic microfracture for treating of osteochondral lesions of the knee.
MATERIALS AND METHODS
We reviewed 12 cases (12 patients) of arthroscopic microfracture and 10 cases (9 patients) of OAT. The mean patient ages were 33.5 years in the microfracture group and 31.3 years in the OAT group. The mean follow-up period was 31.1 months. The mean lesion sizes were 12.9x17.4 mm in the microfracture group and 16.1x21.4 mm in the OAT group. We compared clinical results using the Tegner activity score, the Lysholm knee scoring scale, the IKDC and the VAS. MRI was used to determine the recovery of the osteochondral lesions at last follow-up.
RESULTS
There was no statistically significant difference between the groups for the Tegner Activity Score. Regarding the Lysholm Knee Scoring Scale, the OAT group had a better overall score than did the microfracture group (p<0.05). Both groups had similar results for the IKDC and VAS. The MRI at the last follow-up showed cartilage recovery in 53% of the microfracture cases (compared to the surrounding cartilage) and in 96.1% of the OAT cases.
CONCLUSION
Microfracture and OAT both offered good clinical results when used to treat active persons in the 3rd or 4th decades of life and who have osteochondral lesions of the knee. However, OAT led to better cartilage recovery on MRI, as well as to better functional results. Therefore, OAT is the recommended method of treatment.

Keyword

Osteochondral lesion; Osteochondral autologous transplantation; Microfracture

MeSH Terms

Avena
Cartilage
Follow-Up Studies
Humans
Knee
Transplantation, Autologous

Figure

• 

  Fig. 1 Locations of osteochondral lesions using the ICRS knee cartilage lesion mapping system.

• 

  Fig. 2 Arthroscopic findings of 35 aged male patients. (A) Pre-operative arthroscopic finding, (B, C, D) Post-microfracture arthroscopic finding.

• 

  Fig. 3 Arthroscopic findings of 30 aged male patients. (A, B) Preoperative arthroscopic finding, (C) Post-osteochondral autologous transplantation arthroscopic finding.

• 

  Fig. 4 Cartilage thickness and degrees of osteochondral lesion healing (a, b: cartilage thickness). *Healing degree (%)=a/b×100.

• 

  Fig. 5 MRI revealed a gap between the lesion and the surrounding cartilage in a 35-year-old woman at 32 months after microfracture.

• 

  Fig. 6 MRI at 50 months after OAT showed well covered cartilage.

• 

  Fig. 7 MRI at 38 months after microfracture showed poorly covered cartilage.

Reference

1. Baumgartner MR, Cannon WD Jr, Vittori JM, Schmidt ES, Maurer RC. Arthroscopic debridement of the arthritic knee. Clin Orthop Relat Res. 1990. 253:197–202.

2. Bović V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc. 1996. 3:262–264.

3. Buckwalter JA, Mankin HJ. Articular cartilage: degeneration and osteoarthrosis, repair, regeneration, and transplantation. Instr Course Lect. 1998. 47:487–504.

4. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997. 13:456–460.

5. Dandy DJ. Arthroscopic debridement of the knee for osteoarthritis. J Bone Joint Surg Br. 1991. 73:877–878.

6. Detterline AJ, Goldberg S, Bach BR Jr, Cole BJ. Treatment options for articular cartilage defects of the knee. Orthop Nurs. 2005. 24:361–366.

7. Frisbie DD, Trotter GW, Powers BE, et al. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg. 1999. 28:242–255.

8. Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc. 2005. 13:213–221.

9. In : Gross AE, Hangody L, Minas T, O'Driscoll SW, editors. The surgical treatment of articular cartilage defects of the knee. 2001. Abstracts of the sixty-eighth Annual Meeting of the American Academy of Orthopaedic Surgeons; San Francisco, USA.

10. Gudas R, Kalesinskas RJ, Kimtys V, et al. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy. 2005. 21:1066–1075.

11. Hangody L, Feczkó P, Bartha L, Bodó G, Kish G. Mosaicplasty for the treatment of articular defects of the knee and ankle. Clin Orthop Relat Res. 2001. 391:Suppl. S328–S336.

12. Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am. 2003. 85:Suppl. S25–S32.

13. Hangody L, Kish G, Karpati Z, Szerb I, Udvarhelyi I. Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc. 1997. 5:262–267.

14. Hangody L, Kish G, Kárpáti Z, Udvarhelyi I, Szigeti I, Bély M. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Orthopedics. 1998. 21:751–756.

15. Hangody L, Ráthonyi GK, Duska Z, Vásárhelyi G, Füles P, Módis L. Autologous osteochondral mosaicplasty Surgical technique. J Bone Joint Surg Am. 2004. 86:Suppl 1. S65–S72.

16. Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002. 18:730–734.

17. Hunziker EB. Articular cartilage repair basic science and clinical progress. A review of the current status and prospects. Osteoarthritis Cartilage. 2002. 10:432–463.

18. Knutsen G, Engebretsen L, Ludvigsen TC, et al. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am. 2004. 86:455–464.

19. Korkala OL, Kuokkanen HO. Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts. Arch Orthop Trauma Surg. 1995. 114:253–256.

20. Minas T, Nehrer S. Current concepts in the treatment of articular cartilage defects. Orthopedics. 1997. 20:525–538.

21. Outerbridge HK, Outerbridge RE, Smith DE. Osteochondral defects in the knee A treatment using lateral patella autografts. Clin Orthop Relat Res. 2000. 377:145–151.

22. Prakash D, Learmonth D. Natural progression of osteochondral defect in the femoral condyle. Knee. 2002. 9:7–10.

23. Rodrigo JJ, Steadman JR, Silliman JF, Fulstone HA. Improvement of full-thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg. 1994. 7:109–116.

24. Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full thickness defects of articular cartilage. J Bone Joint Surg Am. 1993. 75:532–553.

25. Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003. 19:477–484.

26. Steadman RJ, Rodkey WG, Singleton SB, et al. Harner CD, Vince KG, Fu FH, editors. Microfracture procedure for treatment of full-thickness chondral defects: technique, clinical results, and current basic science status. Techniques in knee surgery. 2001. Wilkins: Lippincott Williams & Philadelphia;23–31.

27. Woo SLY, Kwan MK, Lee TQ. Perichondrial autograft for articular cartilage. Shear modulus of neocartilage studied in rabbits. Acta Orthop Scand. 1987. 58:510–515.