Autologous osteochondral transplantation for treatment of cartilage defects in osteoarthritic knee: preliminary results

Abstract

Introduction: Osteoarthritis is a contributing factor for pain and loss of function of the knee. Osteoarthritis results in many damages to the knee; one of the most common damages that is difficult to recover is cartilage injury. This study aims to apply autologous osteochondral transplantation (OAT) under knee arthroscopy for the treatment of knee cartilage defects. Methods: This was a prospective, descriptive and non-controlled study. Patients were diagnosed as having osteoarthritis, as confirmed by 1cm 2 -3cm 2 cartilage defects. Arthroscopic OAT was performed on each patient. Treatment efficacy and safety were evaluated based on Lysholm, Oxford Knee Scores (OKS) and pain scales (VAS) after 3, 6, 12 and 18 months. Results: From 3/2014 -8/2016, 61 cases (54 women and 7 men) participated in the study. The average age was 55 ± 8 years old. Most cases had cartilage defects in the medial condyle. Results showed that Lysholm, OKS scores and VAS scales improved after 12 months of treatment. Of the cases, 33 of 61 were followed out to 18 months; these patients showed improvement in knee function and pain scores. There was 1 case with incomplete matching between the plug and receiving site and 1 case with a broken plug. At the final stage of monitoring, there were no patients who experienced complications, such as broken instruments or fracture of condyle, nor who experienced early postoperative complications, such as infection and bleeding. Conclusion: Autologous osteochondral transplantation via arthroscopy is a safe and promising method for the treatment of knee cartilage defects in patients with average osteoarthritis.

Arthroscopic versus Open Osteochondral Autograft Transplantation (Mosaicplasty) for Cartilage Damage of the Knee: A Systematic Review

“…[20][21][22][23][24]26,[28][29][30][31][32][34][35][36]39,43 Data collection was prospectively conducted in 13 of 24 studies (54%). 19,20,24,26,29,30,32,33,[35][36][37]40,42 Two studies (8%) reported an unbiased assessment of the study endpoint. 32,38 Furthermore, only two studies conducted sufficient prospective calculation of the study size for estimating the improvement of the clinical outcomes using OAT.…”

“…In six studies, partial weight bearing was prescribed soon after surgery, 24,26,33,34,37,41 whereas several studies required longer NWB periods (i.e., for more than 6 weeks). 18,31,42 FWB was allowed anywhere from 2 weeks 36,37 to 10 weeks 22 postoperatively.…”

“…In almost all included studies, patients were diagnosed with full-thickness cartilage damage categorized into class 3 or 4 according to the International Cartilage Repair Society scales 44 and the Outerbridge classification. 45 Many varieties of measuring scales for clinical outcomes were used, including the Lysholm score, 20,21,24,25,29,30,35,37,42 the modified Hospital for Special Surgery knee score (HSS), 18,20,39,40,43 the Tegner activity scale, 20,28,31,34,38 the Knee Injury and Osteoarthritis Outcome Score, 23,30,31 the International Knee Documentation Committee score, 25,31,32,34,37 pain examined with a visual analogue scale (VAS: 0-10), 22,24,25,28,33,34,36,37,42 Western Ontario and McMaster universities Osteoarthritis Index, 28,33 Kujala, 29,36 the 36-Item Short Form Health Survey, 29 the Cincinnati Knee Score, 17 the modified Cincinnati score, …”

“…Fourteen out of 24 studies performed postoperative MRI, [18][19][20][21][22][23][24][25]28,29,31,36,38,42 though only six studies quantitatively evaluated the cartilage conditions, including the progression of osteoarthritis. 23,25,28,31,38,42 Magnetic resonance observation of cartilage repair tissue (MOCART) score was prominently used in four studies, 25,31,38,42 whereas the modified Sanders score 23 and the modified Henderson score 28 were each only used in a single study, respectively. The MOCART scores were calculated with nine domains: degree of defect repair and filling, integration with adjacent cartilage to border zone, surface of the repair tissue, structure of the repair tissue, signal intensity of the repair tissue in comparison to the adjacent cartilage, subchondral lamina, subchondral bone, adhesion, and effusion.…”

“…In subgroup analysis, five studies were categorized into OAT, 24,29,32,41,42 whereas 10 studies were categorized into mosaicplasty. 18,20,21,[23][24][25]28,31,33,38 Numbers of inserted plugs in OAT (1.27 AE 0.69) were smaller than those in mosaicplasty (3.74 AE 0.92).…”