Course 206

New frontiers in articular cartilage injury

Indications

Arthroscopic osteochondral autografting is merely the extension of an open technique previously used in which a portion of the femoral condyle is transplanted to a weight-bearing area with a defect.2 The current indications for this procedure are full thickness articular cartilage defects on the weight bearing surface of the medial or lateral femoral condyle measuring between 1 and 2.5 cm in diameter (Fig 1). The presence of multiple lesions is not a contraindication, but associated

Technique

The technique consists of 5 basic steps: preparation of the lesion, determining the number of grafts, drilling the insertion site holes, graft harvest, and graft placement.

Postoperative protocol

Immediate, early motion is allowed after the procedure. No postoperative brace is required. In order to minimize the potential to dislodge the press-fit grafts, the patient is kept non-weight bearing for the first 3 weeks. Progressive weight bearing is allowed between 3 and 6 weeks, and full weight bearing after 6 weeks. During this time, a progressive strengthening program is followed to maintain quadriceps strength. Running is allowed at 12 weeks and full athletic activity at 4 months.

Clinical experience

Our experience with chondral osseous transplantation dates from 1995. The initial patient recently was arthroscopically evaluated 8 years after the index procedure. The graft sites appeared viable without delamination or articular cartilage deterioration. The clinical experience with patients undergoing arthroscopic osteochondral transplantation at 2 centers includes arthroscopic relooks and recipient site biopsy in selected cases.

Evaluations by physical and radiographic examinations, and

Complications and pitfalls: how to avoid them

Potential complications include failure of the press-fit fixation with the creation of a loose body, the possibility of additional damage to the articular cartilage when an attempted graft harvest fails at one site or the articular cartilage of the plug harvested is too angled relative to the cancellous segment to use, and failure of the plugs to heal. Attention to the initial portal placement is critical and placing the portal so the approach to graft harvest and graft insertion is

Discussion

Common treatments of osteochondral defects include debridement and drilling.4, 5, 6 These result in bleeding of the defect bed that does not lead to the development of hyaline articular cartilage but rather fibrocartilage, which does not have an equivalent durability.7, 8, 9

Healthy, supportive subchondral bone is necessary for articular cartilage transplants to remain viable.10 Replantation of cartilaginous loose bodies without any attached bone does not succeed. Even if there is associated