Autogenous Osteochondral Grafts for Osteonecrosis of the Femoral Condyle

Kotani, Akihiro; Ishii, Yoshiaki; Sasaki, Shigeru

doi:10.1177/230949900301100203

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…OAT was introduced as a treatment option involving the transplantation of multiple cylindrical osteochondral grafts from the relatively less weight-bearing periphery of the articular surface to the cartilage defect, 15 and it was an option for the treatment of SONK. 10,[16][17][18] Better long-term clinical outcomes of isolated OAT than microfracture have been reported in the treatment of focal chondral and osteochondral defects of the weight-bearing area. 19,20 However, patients with a cartilage lesion in the medial femoral condyle often show varus knee deformity, and such malalignment is a potential failure risk with an isolated procedure of cartilage repair.…”

Section: Discussionmentioning

confidence: 99%

Minimum 5-Year Outcomes of Osteochondral Autograft Transplantation with a Concomitant High Tibial Osteotomy for Spontaneous Osteonecrosis of the Knee with a Large Lesion

et al. 2022

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Objective The purpose of this study was to evaluate the mid-term clinical outcomes of osteochondral autograft transplantation (OAT) with concomitant high tibial osteotomy (HTO) in spontaneous osteonecrosis of the knee (SONK) with a large lesion. Design A total of 48 knees of 48 consecutive patients with SONK (lesion size ≥4 cm2, no age criteria) who underwent opening wedge HTO and concomitant OAT were retrospectively investigated, and those who were followed up postoperatively for at least 5 years were included in this case series study. Clinical outcomes were evaluated using knee and function scores of Knee Society Score, radiographic outcomes were evaluated using the anatomical femorotibial angle (FTA), and these outcomes were compared between patients aged ≥70 years and <70 years. Results Of the 48 cases, a total of 43 cases were available for review at a minimum of 5 years, and 5 cases were excluded from the analysis. Overall, the mean knee score improved from preoperative 48.8 ± 13.3 to postoperative 87.9 ± 8.6 at 1 year ( P < 0.05) and 85.0 ± 10.4 at final follow-up ( P < 0.05 vs. preop., N.S. vs. 1 year). The mean function score also improved from preoperative 60.1 ± 10.9 to postoperative 87.3 ± 12.2 at 1 year ( P < 0.05) and 84.2 ± 12.4 at final follow-up ( P < 0.05 vs. preop., N.S. vs. 1 year). The mean standing FTA was corrected significantly from 181.1° ± 2.7° preoperatively to 169.7° ± 2.4° at 1 year ( P < 0.05) and 169.4° ± 3.1° at final follow-up ( P < 0.05 vs. preop., N.S. vs. 1 year). There were no significant differences in clinical and radiographic outcomes between patients aged ≥70 years and <70 years. There were 4 cases of lateral hinge fracture around the osteotomy site and 1 case of delayed union. None of the patients underwent revision surgery during the follow-up period (survival rate of 100%). Conclusions Mid-term clinical outcomes of patients with SONK who underwent HTO and OAT with a relatively large lesion were good.

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Section: Discussionmentioning

confidence: 99%

Minimum 5-Year Outcomes of Osteochondral Autograft Transplantation with a Concomitant High Tibial Osteotomy for Spontaneous Osteonecrosis of the Knee with a Large Lesion

et al. 2022

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“…Kotani et al reported good outcomes of OAT in patients with osteonecrosis of the medial femoral condyle. 12 Although OAT is a good treatment for osteochondral injury and osteochondritis dissecans, the size of the lesion may be as long as the length of a plug, which is generally 15–20 mm in size, and the diameter of the graft is 6–10 mm. Therefore, good stability of the plug may not be obtained in deeper and larger defects.…”

Section: Discussionmentioning

confidence: 99%

High tibial osteotomy combined with cancellous bone graft and osteochondral autograft transplantation in a patient with massive osteochondral defects in the medial femoral condyle

Matsushita

Watanabe

Araki

et al. 2017

J Orthop Surg (Hong Kong)

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Treatment of massive osteochondral defects of the medial femoral condyle is challenging. A 46-year-old man who had a medial femoral condyle fracture on his left knee underwent osteosynthesis in a hospital, but the pain remained and the patient was referred to our hospital 8 months after the surgery. Radiographs showed a varus alignment of the leg, and magnetic resonance image showed a massive necrotic area in the medial femoral condyle. The patient received high tibial osteotomy (HTO) combined with iliac cancellous bone graft and an osteochondral autograft transplantation. Pain and the knee function markedly improved 2 years after the surgery. A second look arthroscopy showed a well-covered bone graft site with cartilaginous tissue and a well-integrated osteochondral plug. HTO combined with cancellous bone autograft and osteochondral autograft transplantation could be an effective treatment for patients presenting with a varus knee deformity associated with massive osteochondral defects in the medial femoral condyle.

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“…Multiple small case series [5][6][7][8][9] have described the success of osteochondral autografts for treatment of osteochondral defects in the knee, including cases of spontaneous osteonecrosis of the knee (SONK), secondary osteonecrosis, or osteochondritis dissecans. As for other small osteochondral defects, osteochondral autograft plugs are harvested from the periphery of either the ipsilateral or contralateral knees.…”

Section: Discussionmentioning

confidence: 99%

Knee Joint Osteochondral Reconstruction Using Fresh Femoral Head Autograft

Weinrauch¹

2013

J Med Cases

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We present the management of polyarticular osteonecrosis in a 17-year-old female, with marked symptoms involving both hips and one knee. As a complication of chemotherapy to treat leukaemia, the articular surfaces of both femoral heads and the right knee lateral femoral condyle collapsed, resulting in significant pain and disability. For this unusual case a novel technique was employed, using a method we believe has not been described previously. The articular surface of the knee was reconstructed using fresh bulk osteochondral autograft harvested from the ipsilateral femoral head during a simultaneous total hip arthroplasty. Reconstructive options in young patients with multiple joints involved are often restricted, and suitable osteochondral allografts can be difficult to obtain. Fresh osteochondral auto-grafting enabled rapid osseous integration and articular surface reconstruction using living host cartilage, resulting in an excellent clinical outcome. Although uncommon, concurrent avascular necrosis of multiple large joints is occasionally encountered, and management options are particularly limited in young patients. We recommend this innovative technique be considered in those patients who satisfy the criteria for bulk osteochondral grafting procedures where total hip replacement is also required.

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Autogenous Osteochondral Grafts for Osteonecrosis of the Femoral Condyle

Abstract: Transplant surgery using osteochondral autografting appeared effective for the treatment of osteonecrosis of femoral condyle.

Cited by 9 publications

References 7 publications

Minimum 5-Year Outcomes of Osteochondral Autograft Transplantation with a Concomitant High Tibial Osteotomy for Spontaneous Osteonecrosis of the Knee with a Large Lesion

Minimum 5-Year Outcomes of Osteochondral Autograft Transplantation with a Concomitant High Tibial Osteotomy for Spontaneous Osteonecrosis of the Knee with a Large Lesion

High tibial osteotomy combined with cancellous bone graft and osteochondral autograft transplantation in a patient with massive osteochondral defects in the medial femoral condyle

Knee Joint Osteochondral Reconstruction Using Fresh Femoral Head Autograft

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