2017 ISAKOS Biennial Congress ePoster #236

 

Osteo-Chondroisation: A preliminary report For Treament Of Pure Cartilage Defects In The Knee

Robin Martin, MD, Lausanne SWITZERLAND
Roland P. Jakob, Professor Emeritus, Môtier SWITZERLAND
Lausanne University Hospital, Lausanne, SWITZERLAND

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Geistlich Medical, Chondro-Gide membrane

Summary

We present a clinical hypothesis for a single step surgical treatment of grade 4 cartilage defects in the knee. Its strength would be a spontaneous repair response from the bone-marrow spaces. Cancellous bone is a source of MSC’s that can differentiate in osteogenic and chondrogenic liners according to their localization (Homing mechanism). Since a sclerotic subchondral plate is a barrier for vasc

Abstract

Purpose

Good long term results (Kusano, 2012) using the AMIC procedure in OCD’s of the femoral condyles have stimulated us to prospectively apply the same principles in pure chronic cartilagelesions of the patellofemoral joint (PFJ).

Methods

and Materials: First the lesion is transformed in an osteochondral defect by removal of the sclerotic subchondral plate 4 mm deep, similar to Ficat (1979) in his “spongiolisation” procedure. It is filled with fresh cancellous bone retrieved from the tibia, flush to the neighbouring subchondral plate. A bilayer collagen I/III membrane is sutured over
it. Concomitantly, alignment procedures for patella instability are performed.

Results

We report 5 cases, with ICRS grade 4 patellar lesions and severe PFJ instability. All received trochleoplasty, tibial tubercle transfer, lateral Z plasty, medial patellofemoral reconstruction, and Osteo-chondroisation.
Mean follow up was 1.1 yr. Lesion size 3.9 ±1.7 cm2. Pain on VAS decreased from 6.4 to 2.4 postop . Kujala score improved from 40.8 to 74.2. One case developed arthrofibrosis, requiring artholysis. Postoperative MRI
at 6 and 12 months have shown complete filling of the defect, complete integration to the grafted bone with reformation of the subchondral plate, and homogeneous tissue with Dual T2 FSE isointense signal in 4 cases.

Conclusion

We present a clinical hypothesis for a single step surgical treatment of grade 4 cartilage defects in the knee. Its strength would be a spontaneous repair response from the bone-marrow spaces. Cancellous bone is asource of MSC’s that can differentiate in osteogenic and chondrogenic liners according to their localization (Homing mechanism). Since a sclerotic subchondral plate is a barrier for vascularization, its removal combined with a stem-cell rich bone graft is a prerequisite for substantial fibrocartilage regeneration. The weakness of this small unconventional series is of course the short follow-up and the lack of animal experimentation that is planned in future.

Return to ePoster List