Osteochondral autograft transplantation versus autologous bone-cartilage paste grafting for the treatment of knee osteochondritis dissecans

Abstract

Purpose To compare the results of two groups of patients affected by osteochondritis dissecans (OCD) of the knee and treated with either osteochondral autologous transplantation (OAT) or bone-cartilage paste grafting (PG). Methods A total of 27 patients affected by OCD lesions of the femoral condyles were included: 15 treated with OAT, 12 with PG, with comparable baseline characteristics (mean age 22.4 ± 7.2 vs. 24.2 ± 8.5 p = n.s., mean defect size 2.2 ± 1 cm2 vs 2.6 ± 1 cm2p = n.s.). Patients were evaluated pre-operatively and at 24 and 84 months post-operatively with the International Knee Documentation Committee (IKDC) subjective and objective scores. Sport activity level was evaluated with the Tegner activity score. Adverse events and failures were also recorded. Results The IKDC subjective score improved significantly in both groups. At 24 months, a significant improvement from 53.4 ± 9.1 to 80.8 ± 12.9 (p = 0.005) was obtained in the OAT group and from 44.6 ± 11.0 to 71.4 ± 25.3 in the PG group (p = 0.008). A further statistically significant increase was observed at 84 months in both groups. No significant differences were found between OAT and PG at both follow-ups. One OAT patient required post-operative knee mobilization under narcosis and two complained of donor site symptoms. More failures were documented in the PG vs OAT group (25% vs 0%; p = 0.043). Conclusion Both PG and OAT provided overall satisfactory results up to 84 months follow-up. However, while PG presents the advantages of a less invasive approach with lower adverse events, the higher failure rate of PG should be considered when choosing between these two surgical treatment options for restoration of the articular surface in patients affected by knee OCD.

Osteoarthritis: an ancient disease, an unsolved conundrum

“…The advance in the knowledge of the pathologic changes affecting both the intra and extra-articular tissues has allowed us to better approach OA and target selectively those problems with a "joint sparing" philosophy, which could be helpful in decreasing morbidity for our patients and also minimizing the economic burden associated to arthroplasties. Anyway, "joint sparing surgery" not only refers to biologic products but also includes more traditional and consolidated approaches for treating cartilage defects [22,23] or for restoring the native biomechanical function of the joint: in particular, osteotomy, as shown by some papers included in this Special Issue [24,25] still represents a valid therapeutic option, which can be combined with more modern treatments, such as application of MSCs [18], to enhance clinical outcomes and improve articular homeostasis. Lastly, in case of severe damage, joint replacement shall not be considered something to fear, since modern techniques, as shown by Mosca et al [26] in the case of ankle arthroplasty, aims at restoring the native biomechanics with a significant functional improvement perceived by patients and a modest complication rate.…”

Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint

“…Since then, encouraging results have been reported [53][54][55][56]. However, the results have appeared to be highly dependent on lesion size [57]. In fact, while Smolders et al [54] described satisfactory results treating OCD lesions ranging from 0.5 to 3.2 cm 2 , and other studies reported that OAT provides good-to-excellent results when applied to smaller articular cartilage between 1 and 4 cm 2 [58], lesions > 6 cm 2 are associated with a poor prognosis, even when multiple graft plugs are used [53].…”

Nanofiber scaffolds based on extracellular matrix for articular cartilage engineering: A perspective

“… Schematic representation of osteochondral autograft transplantation. Reproduced with permission 35 . Copyrighted by the Authors (2021).…”