Description
Objectives: Autogenous osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness. The purpose of this study was to review the results of 48 patients with 48 knees undergoing osteochondral autograft to repair focal full-thickness articular cartilage defects of the knee with a minimum of 2 years follow-up.
Methods: 48 patients with 48 knees undergoing autogenous osteochondral graft for focal articular cartilage defects of the knee between January 2000 to June 2018 were included in this study. We exclude patients with ACL and meniscus injury. There were 27 men and 21 women with an average age of 33 (range 20-55) years old. There were 32 right knees and 16 left knees. The average duration of symptoms was 13.6 (range 4-40) months, and the average follow-up time was 24 (range 22-27) months.
The locations of the lesion included the lateral femoral condyle in 18 knees, medial femoral condyle in 30 knees. The average size of the lesion was 3,3 (range 1,3-4,9) cm2 for the lateral femoral condyle and 2,07 (range 1,2 -3,75) cm2 for the medial femoral condyle. The types of injury included 8 motor vehicle accidents, 19 falling accidents, 14 sports-related injuries (2 basketball and l badminton, 4 – tennis, 7 - football), 7 work-related.
Results: All patients were operated on because of knee pain ranging from mild to severe preoperatively. Postoperatively, 39 of 48 knee (81,25%) had no pain and 9 knees (18,75%) showed mild pain (p=0.001). The duration to pain relief of the knee ranged from 6 to 16 weeks after surgery. Knee locking was noticed in 45 knees (93.73%) preoperatively and no 3 (6,25%) postoperatively (p=0.001). Recurrent knee effusion was seen in 44 of 48 knees (91.6%) preoperatively and in only 4 knee (8.4%) postoperatively (p=0.002). The average range of knee motion was 122.8°±8.8° preoperatively vs 134.4°±7.9°postoperatively (p=0.005). The average Lysholm scores were 67.9±12.4° preoperatively vs 90.4°±10.1° postoperatively (p=0.001). The average knee score was 94±12 and the average functional score 88±15 at follow-up. . The overall results were excellent in 7 (43.75%), good in 6 (37.50%), fair in 2 (12.50%), and poor in l (6.25%).
Postoperatively, the incidence of degenerative changes of the knees by radiographic examination was noticed in 7 knees with 4 in the medial compartment, 3 in the lateral compartment (14,5%).
Conclusions: There was no direct correlation of the clinical results with the sizes of the lesions smaller than 5 cm, but lesions larger than
5 cm2 tended to result in increasing fibrous tissue formation and fissuring between the grafts and the surrounding tissues and poor results. The improvement of knee pain was time-dependent, ranging from 6 to 16 weeks, and postoperative protection of the graft was warranted. It appears that an osteochondral graft has the potential to prevent or delay the development of degenerative changes of the knee in the medium-term follow-up
