The Utilisation of Osteochondral Autografts
in the Treatment of Articular Cartilage Lesions (Part 3 of 3)

Vladimir Bobic, M.D.
Consultant Orthopaedic Knee Surgeon
The Royal Liverpool University Hospitals, Broadgreen Hospital Knee Service, Liverpool, The Grosvenor Nuffield Hospital Knee Clinic, Chester, United Kingdom

OAT Evaluation

Second-look Arthroscopy:

Single 10 mm graft after 3 years (Vladimir Bobic, 1996)

Single 10 mm graft after 1 year (Craig Morgan, 1998

Magnetic Resonance Imaging:

High resolution 3D MRI can be used instead of second-look arthroscopy and biopsy.

MR image opposite: single 10 mm osteochondral autograft after 6 months: good bone integration, good cartilage cover, congruent articular surface (The University of Liverpool MRI Research Center, Liverpool, UK).

Relatively new techniques like high-resolution short echo time spectroscopic imaging provide ultra-short echo time high resolution images of cartilage over a small area, in addition to spectroscopic data. It is possible that this method can be used to distinguish between hyaline and fibrocartilage (Stanford University). This MRI technique includes immunity to metallic artefacts. Gradient echo sequences are prone to magnetic susceptibility artefact, which is accentuated in the presence of orthopaedic instruments, especially following OAT procedure.

MR image opposite: two 10 mm trochlear osteochondral graft transplants after 3 months. Metallic artefacts are visible as black speckles on the left side of the picture, close to the patella and medial femoral condyle.

The Royal University Hospitals MRI

OAT New Developments: large harvesters (10-14 mm) for fresh osteochondral allografts. Porous hydroxyapatite (HA) rods for grafting donor sites, to obliterate deep dead spaces between osteochondral autografts, and to provide scaffolding in the reconstruction of subchondral bone. Blood clot inserted into recipient site to enhance early bone to bone healing and full integration of cancellous bone. Locally produced autologous chondrocytes applied to mechanical carrier (cancellous bone or HA) to obliterate dead spaces between circular osteochondral autografts. Growth factors (TGF-ß) to stimulate cell production and integration of hyaline cartilage (recipient-donor interface). Biological glues to seal cartilage-cartilage interface.

OAT Problems: availability of grafts, size and depth of defects, dead spaces between circular grafts, integration of donor to recipient hyaline cartilage, different mechanical properties of donor to recipient hyaline cartilage.

Summary: at present, osteochondral autograft transplantation is the only surgical technique that can replace and retain hyaline articular cartilage. Osteochondral autograft transplants have been associated with a good rate of success, but further long-term follow-up and biomechanical evaluation are essential.

"Because of the small number of possible donor sites from which osteochondral autologous grafts may be obtained, use of these grafts has been limited to selected localised regions of damaged articular cartilage. In a small number of patients, surgeons have replaced damaged or lost articular surfaces with autologous grafts of articular cartilage É, and the results have shown that this technique can restore an articular surface. The long-term follow-up of small series of patients has shown that the transplantation of osteochondral autologous grafts ... can be effective for the treatment of focal defects of articular cartilage in selected patients."

-Buckwalter and Mankin, 1997.

OAT Bibliography

1. Beadling L, Trace R. WORLD OF OPPORTUNITY FOR OSTEOCHONDRAL TRANSPLANTATION. Orthopaedics Today 1996;16 (9) 17-19.

2. Bobic V: ARTHROSCOPIC OSTEOCHONDRAL AUTOGRAFT TRANSPLANTATION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A PRELIMINARY CLINICAL STUDY. Knee Surg Sports Traumatol Arthrosc 1996; 3:262-264.

3. Buckwalter JA, Mankin HJ. ARTICULAR CARTILAGE. J Bone Joint Surg 1997;79-A (4) 600-632.

4. Dew T L, Martin R A. FUNCTIONAL, RADIOGRAPHIC AND HISTOLOGICAL ASSESSMENT OF HEALING OF AUTOGENOUS OSTEOCHONDRAL GRAFTS AND FULL-THICKNESS CARTILAGE DEFECTS IN THE TALUS OF DOGS. Am J Vet Res 1992;53 (11) 2141-2152.

5. Fabbriciani C, et al. OSTEOCHONDRAL AUTOGRAFT IN THE TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE. Read at the 17th AOSSM Annual Meeting, Orlando, USA, Book of Abstracts 1991; 67-68.

6. Hangody L, et al. AUTOGENOUS OSTEOCHONDRAL GRAFT TECHNIQUE FOR REPLACING KNEE CARTILAGE DEFECTS IN DOGS. Orthopaedics International 1997 (5) 3:175-181.

7. Hangody L, et al. ARTHROSCOPIC AUTOGENOUS OSTEOCHONDRAL MOSAICPLASTY FOR THE TREATMENT OF FEMORAL CODYLAR ARTICULAR DEFECTS. Knee Surg Sports Traumatol Arthrosc 1997; 5:262-267.

8. Lane J M, et al. JOINT RESURFACING IN THE RABBIT USING AN AUTOLOGOUS OSTEOCHONDRAL GRAFT. A BIOCHEMICAL AND METABOLIC STUDY OF CARTILAGE VIABILITY. J Bone Joint Surg 1977;59-A: 218-222.

9. Levy A S, Lohnes J, Sculley S, LeCroy M, Garrett W. CHONDRAL DELAMINATION OF THE KNEE IN SOCCER PLAYERS. Am J Sports Med 1996:24 (5) 634-639

10. Matsusue Y, Yamamuro T, Hama H. CASE REPORT: ARTHROSCOPIC MULTIPLE OSTEOCHONDRAL TRANSPLANTATION TO THE CHONDRAL DEFECT IN THE KNEE ASSOCIATED WITH ANTERIOR CRUCIATE LIGAMENT DISRUPTION. Arthroscopy 1993; 9: 318-321.

11. Müller W. OSTEOCHONDROSIS DISSECANS. In: Progress in Orthopaedic Surgery, ed. D E Hastings, Springer, New York 1978, 3, 135.

12. Noyes F R, Stabler C L. A SYSTEM FOR GRADING ARTICULAR CARTILAGE LESIONS AT ARTHROSCOPY. Am J Sports Med 1989;17:505-513.

13. Outerbridge H K, Outerbridge A R, and Outerbridge R E. THE USE OF A LATERAL PATELLAR AUTOLOGOUS GRAFT FOR THE REPAIR OF A LARGE OSTEOCHONDRAL DEFECT IN THE KNEE. J Bone Joint Surg 1995;77-A: 65-72.

14. Roffman M. AUTOGENOUS GRAFTING FOR AN OSTEOCHONDRAL FRACTURE OF THE FEMORAL CONDYLE: A CASE REPORT. Acta Orthop Scand, 1995;66 (6) 571-572.

15. Wilson WJ, Jacobs JE. PATELLAR GRAFT FOR SEVERELY DEPRESSED COMMINUTED FRACTURES OF THE LATERAL TIBIAL CONDYLE. J Bone Joint Surg 1952; 34-A: 436-442.

16. Yamashita F, Sakakida K, Suzu F, Takai S. THE TRANSPLANTATION OF AN AUTOGENIC OSTEOCHONDRAL FRAGMENT FOR OSTEOCHONDRITIS DISSECANS OF THE KNEE. Clin Orthop 1985; 201: 43-50.

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