Revista de la Asociación Argentina de Ortopedia y Traumatología
On-line version ISSN 1852-7434
MASTROPIERRO, Javier; CICCARELLO, Víctor Andrés and DAVILA, Alberto. Osteochondral autograft of the knee: Clinical and radiological outcome. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2012, vol.77, n.1, pp. 57-65. ISSN 1852-7434.
Background: The damaged articular cartilage has limited potential for repair. The treatment of osteochondral lesions in load bearing areas of the knee, are a therapeutic challenge. There are different cartilage repair techniques available. The main objective of these is achieving restoration of the congruity of the articular surface. Objectives : The objective was to compare clinical outcomes, assessed with the score of ICRS (International Cartilage Repair Society) with magnetic resonance images (MRI) of osteochondral autografts. Methods: Over a period of 4 years were performed 35 transplants of autologous osteochondral plugs (mosaico-plasty) in patients with lesions of the articular cartilage of the knee Outerbridge grade IV, smaller an 2.5 cm in diameter. The average patient age was 30.5 years. The average follow-up was 36 months. In 12 patients was conducted jointly ACL reconstruction. In a patient with a meniscal suture, 13 patients with partial lateral meniscectomy, and 15 partial medial meniscectomy. We designed a classification into three groups A, B and C taking into account 5 items that were valued in the postoperative MRI: degree of defect fill, restoration of the radius of curvature, angle of the curvature, a percentage of the implanted cartilage thickness over the surrounding, peripheral integration of subchondral bone. Results: We obtained good to excellent results in 87.5% of patients. Not finding a significant clinical-radiological correlation in the postoperative evaluation with MRI. Conclusions: MRI allows us to analyze a series of data after an osteochondral transfer that are useful for monitoring the process of incorporation of the graft and cartilage regeneration of the articular surface. Small variations in the orientation of the osteochondral graft, or slight irregularities at the level of the chondral surface of the graft does not appear to correlate with adverse clinical outcomes in the short term. MR imaging of knee cartilage sequence, among other studies, would be needed for more accurate evaluation. We conclude that mosaico-plasty is a safe and effective for treatment of grade IV osteochondral lesions, small in young patients with good results in the medium term. Although it would take longterm monitoring to observe that these cases are not progressing with time of knee osteoarthritis.
Keywords : Osteochondral autografting; NMR; Osteo-chondral injury.