cartilage repair using combined OAT and MF technique in younger patients could be a good alternative to TKR for severe osteoarthritis which lesion size of MFC is so extensive that it is hard to get successful cartilage repair with mosaicplasty only or microfracture only technique.
There has been a general concensus that it is hard to expect successful cartilage repair with mosaicplasty only or microfracture only technique for extensive lesion of severe osteoarthritis. The purpose of the study was to evaluate arthroscopic, radiologic, and clinical results of cartilage repair using combined osteochondral autograft transfer(OAT) and microfracture(MF) technique for severe osteoarthritis of the knee in younger patients.
< Methods >
We performed arthroscopic microfracture for medial tibial plateau(MTP) Grade(G) 4 lesion , combined OAT and MF for medial femoral condyle(MFC) G 4 lesion , and medial opening wedge HTO for 63 knees of 58 patients. Postoperatively continuous passive motion (CPM) exercise was encouraged 6 hours per day for 6 weeks. We analysed the status of cartilage repair which was assessed by ICRS grading (G) on second look arthroscopy conducted around postoperative 1 year, radiologic results which was evaluated by Kellgren-Lawrence(K-L) grading and MOCART score, clinical results which was investigated with KOOS score, IKDC subjective forms, and KS function score, and patient’s satisfaction in Likert scale. All the parameters were compared according to the postoperative anatomical axis and bifocal repair. Statistical analysis was done with chi-square analysis, student t test, and ANOVA test.
<Results and Conclusions >
Mean age and follow-up period was 52.8 years (range, 39-61 years) and 45.6 months in average( range, 13-87 months), respectively. Lesion size of MFC and MTP was 4.03 ? and 1.30 ? in average, respectively.
On the second-look arthroscopic examination , MFC lesions(n=63) showed very good cartilage repair status( G1 30, G2 26, G3 5, and G4 2 knees postoperatively, compared to all knees in G4 preoperatively). MTP lesions ( n=47) also revealed good cartilage repair ( G1 17, G2 11, G3 15, and G4 4 knees postoperatively, compared to G4 47 knees preoperatively). K-L grading also demonstrated improved results ( G1 2, G2 22, G3 23, and G4 16 knees postoperatively, compared to G3 5, G4 58 knees preoperatively). MOCART score on postoperative MRI was 82.4 in average(range, 60-95). KOOS scores, IKDC scores, and KS function scores were significantly improved postoperatively ( KOOS score: 48.5 vs 77.5, P<0.005, IKDC score: 36.0 vs 66.3, P<0.005, KS function score: 76.4 vs 90.9, P<0.005). Patient satisfaction was 4.0 in average( range,2-5).
Nineteen knees with postoperative anatomical axis of 10 degrees or more showed better results for cartilage repair ( P= 0.053), but not for the clinical results. There was no significant differences according to bifocal cartilage repair in all parameters.
In conclusion, cartilage repair using combined OAT and MF technique in younger patients could be a good alternative to TKR for severe osteoarthritis which lesion size of MFC is so extensive that it is hard to get successful cartilage repair with mosaicplasty only or microfracture only technique.
Key words: Cartilage repair, Combined osteochondral autograft transfer and microfracture technique, Severe Osteoarthritis