2017 ISAKOS Biennial Congress ePoster #207

 

Articular Cartilage Paste Graft for Severe Osteochondral Lesions of the Knee: A 10-23 Year Follow-Up Study

Kevin R. Stone, MD, Mill Valley , CA UNITED STATES
Jonathan Pelsis, MHS, San Francisco, CA UNITED STATES
Kellen Y Na, BS, San Francisco, CA UNITED STATES
Ann W. Walgenbach, RN, NP, MSN, San Francisco, CA UNITED STATES
Thomas J. Turek, PhD, San Francisco, CA UNITED STATES

Stone Research Foundation, San Francisco, CA, UNITED STATES

FDA Status Not Applicable

Summary

This study evaluates the efficacy of autologous osteochondral paste grafting at a mean 16.8 years after surgery.

Abstract

The purpose of this study is to evaluate the clinical outcomes of the articular cartilage paste graft procedure at a minimum of 10 years from surgery. It is hypothesized that articular cartilage paste grafting can provide patients with a durable repair of severe full-thickness osteochondral injuries, measured by persistence of procedure-induced benefit and subjective outcome scores at 10 or more years. Seventy four patients undergoing paste grafting at a mean age of 45.3 ± 10.8 years (range, 13 – 69 years) were followed up at a mean of 16.8 ± 2.4 years (range, 10.6 – 23.2 years) postoperatively using validated subjective outcome measures; Kaplan-Meier survival analysis was performed to estimate expected population benefit time. Kaplan-Meier estimated median benefit time of 19.1 years (mean: 16.6 ± 0.9 years) for all patients undergoing paste grafting. Thirty one (41.9%) patients had progressed to arthroplasty at a mean of 9.8 ± 5.6 years (range: 0.4 – 20.6 years). Ninety percent of patients reported that the procedure provided good to excellent pain relief. Median IKDC subjective score increased significantly at most recent follow-up (70.1) compared to preoperative (55.7, p = 0.013). Median WOMAC scores decreased significantly from 26 to 14 (p = 0.001). Median Tegner score increase from 4 to 6 was not found to be significant (p = 0.119). VAS pain averaged 23/100 at most recent follow-up. Patients who underwent the paste graft reported improved pain, function, and activity levels for an expected mean of 16.6 years, and for those who ultimately progressed to knee replacement, surgical treatment including the paste graft was able to delay arthroplasty until a mean age of 60.2 years, an age at which the procedure is commonly performed. Full thickness articular cartilage loss can be successfully treated, reducing pain and improving function, using this single-step, inexpensive arthroscopic procedure.