March 13th, 2004
AOSSM Specialty Day

Treatment of retropatellar cartilage lesions with autologous osteochondral transplantation - AN MRI controlled follow-up study

Authors:
  1. Vladimir Martinek MD, PhD, Technical University Munich, Munich, Germany
  2. Ulf Boekeler, Technical University Munich, Munich, Germany
  3. Klaus Woertler MD, PhD, Technical University Munich, Munich, Germany
  4. Andreas B. Imhoff MD, Prof., Univ. of Munich Ortho Sports Med., Munich, Germany
Objective:  The management of retropatellar cartilage defects is complex and often associated with disappointing results. The autologous osteochondral transplantation, a relatively new operative method, is still judged with retention due to lacking treatment results. In the following clinical study, we present the outcome of a, up to date largest patient collective following autologous osteochondral transplantation at the patella.
Methods:  Between 1997 and 2002, retropatellar autologous osteochondral transplantation was performed in 27 patients (21 males, 6 females), mean age of 33.4 y. [range 16-29 y.]. In average 2.3 autologous osteochondral cylinders [range 1-4] were transplanted from the proximal lateral trochlea femoris to the retropatellar articular surface. At the same time, a medial tibial tubercle transfer was performed in 27.3%, a lateral release in 65.2% and a proximal soft tissue realignment 39.1% of the cases. A complete follow-up evaluation after 31.4 months [range12-64 months] was available in 24 patients (88.9%). A detailed clinical examination with evaluation of the Lysholm and Tegner scores, the Visual Analogue Scale (VAS, 0= no to 10= worst pain), radiographs and high-field MRI of the knee joint was obtained.
Results:   Twenty patients (83.3%) were fully satisfied with their results and claimed that they would undergo the operative procedure again. At the time of follow-up, 8 patients (33.3%) had a moderate patellofemoral crepitation 2 (8.3%) a mild knee joint effusion and 3 (12.5%) a positive Apprehension sign. The Lysholm Scores improved from 54±22to 81±17 (p<0.001) and the Tegner Scores rose from 2.9±1.7 pre- to 4.6±1.2postoperatively (p<0.001) significantly. The pain score (VAS) reduced from 6.1±1.7 to 3.0±1.2(p<0.001). In the clinically successful cases, the transplanted osteochondral cylinders were completely integrated and the transplanted hyaline cartilage vital at the MRI scans.
Conclusions:  Autologous osteochondral transplantation is a technically demanding operative option for the treatment of patellar cartilage defects. This method offers good mid-term success rates and represents an alternative to bone-marrow stimulating procedure especially in young and active persons. However, long-term evaluations have to be awaited to confirm the feasibility of this treatment method in the future.
Keywords:
  1. Cartilage
 Categories:
  1. CLINICAL: Knee - Articular Cartilage