Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint

Seung Suk Seo; Chang Wan Kim; Dong Jun Ha; Jang Seok Choi; Ho Jun Kim; Chang Rack Lee

doi:10.4055/jkoa.2009.44.3.301

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Seo, Kim, Ha, Choi, Kim, and Lee: Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(3): 301-310.

Published online: 18 June 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.3.301

Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint

Seung Suk Seo, M.D., Chang Wan Kim, M.D., Dong Jun Ha, M.D., Jang Seok Choi, M.D., Ho Jun Kim, M.D.^*, Chang Rack Lee, M.D.

Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Korea.

^*Department of Orthopedic Surgery, Busan Bon Hospital, Busan, Korea.

Address reprint requests to Jang Seok Choi, M.D. Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, 633-165, Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea. Tel: +82.51-890-6129, Fax: +82.51-892-6619, lilac-lee@hanmail.net

Abstract

Purpose

We wanted to evaluate the outcomes of an autologous osteochondral graft (Mosaicplasty) for treating chondral defects of the femoral condyle and We assessed the factors affecting the clinical results.

Materials and Methods

This study enrolled 18 patients (19 cases) who underwent an autogenous osteochondral graft to treat a osteochondral defect in the femoral condyle from July 2000 to June 2006. The average age was 26.2 years old (age range: 16-48 years old). Among the patients, 17 cases were men. In 14 cases, the osteochondral defects were localized in the medial femoral condyle and only 5 cases showed a defect in the lateral femoral condyle. The average size of the osteochondral defects was 4.2 cm² (1-13 cm²). The Lysholm knee scoring scale and the Tegner's activity score were applied for clinical evaluation. Further, we carried out simple X-ray for all the cases and we performed MRI in 5 cases for the radiological evaluation. Tthe factors affecting the clinical results were also analyzed and the complications were evaluated.

Results

The average follow-up period was 22 months (range: 6-55 months). Eighten out of 19 cases (94.7%) were able to return to ordinary life. The Lysholm knee scoring scale and the Tegner's activity score indicated much better clinical results for small lesions and for young patients. For the radiological results, all the cases displayed a decrease in the size of radiolucent zones on the follow up X-ray. Among the 5 cases for which an MRI was performed, graft unions were observed in 3 cases, but 2 cases displayed continuous peri-graft edema. Any other complications involving the donor and recipient site were not observed.

Conclusion

We conclude that autogenous osteochondral grafting is useful for specific patients depending on the size of the lesion and the patient's age. It is a valuable treatment option for osteochondral defects in the knee joint.

Keywords: Femoral condyle, Osteochondral defect, Autogenous osteochondral graft

Figures and Tables

Fig. 1

(A) The overall Lysholm knee scoring scale was increased from 61 in preoperation to 83 in postoperation. (B) Also, Tegner's activity score was improved from 2.4 to 4.9.

Fig. 2

These photos are preoperative radiographs (A, B) and MR images (C, D) of 22 years old patient with a post traumatic osteochondral defect of the medial condyle and intraoperative finding (E) during operation. Preoperative Lysholm knee scoring scale and Tegner's activity score were 59 and 3, respectively. Reconstruction of a joint line is visible in postoperative MR image (F, G) taken 25 months after surgery. Follow up Lysholm knee scoring scale and Tegner's activity score were improved to 76 and 4, respectively.

Fig. 3

(A-C) These photos are preoperative radiographs of 17 years old patient with osteochondritis dissecans of the medial condyle in both femur ((B): Left, (C): Right). (D, E) Large amount of persistent perigraft edema-like signal change is visible in postoperative MRI scan taken 12 months after mosaicplasty. Follow up Lysholm knee scoring scale and Tegner's activity score were not significantly changed, comparing with preoperatives ((D): Left, (E): Right).

Fig. 4

These photos are preoperative radiographs (A, B) and postoperative radiographs (C, D) taken 12 months after mosaicplasty of 43 years old patient with osteonecrosis of the medial condyle in right femur. Preoperative Lysholm knee scoring scale and Tegner's activity score were 63 and 2, respectively. Follow up Lysholm knee scoring scale and Tegner's activity score were improved to 78 and 4, respectively.

Fig. 5

These photos show intraoperative finding of 30 years old patient with an osteochondritis dissecans of the lateral condyle in left femur. The size of osteochondral defect was 13 cm² (A), and 13 plugs were in use (B).

Table 1

Summary of Cases (I)

^*Diameter of plug; ^†Arthroscopic; ^‡Medial; ^§Lateral.

Table 2

Summary of Cases (II)

^*Lysholm knee scoring scale; ^†Tegner's activity score; ^‡Osteochondritis dissecans; ^§Osteonecrosis.

Table 3

Comparison between Young Patients under 30 Years of Age and Middle Aged Patients over 31 Years of Age with Lysholm Knee Scoring Scale and Tegner's Activity Score (Mann-Whitney Test)

^*Preop, preoperative.

Table 4

Comparison between the Group with Small Lesions of less than 4 cm² and the Group with Large Lesions more than 4 cm² with Lysholm Knee Scoring Scale and Tegner's Activity Score (Mann-Whitney Test)

^*Preop, preoperative.

Table 5

Comparison between the Group with Lateral Condylar Lesions and the Group with Medial Condylar Lesions with Lysholm Knee Scoring Scale and Tegner's Activity Score (Mann-Whitney Test)

^*Preop, preoperative; ^†Lateral; ^‡Medial.

Table 6

Comparison between the Group with Non-traumatic Lesions and the Group with Traumatic Lesions with Lysholm Knee Scoring Scale and Tegner's Activity Score (Mann-Whitney Test)

^*Preop, preoperative.

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