Autologous Costal Cartilage Grafting for a Large Osteochondral Lesion of the Femoral Head

Abstract

Background:There is currently no ideal treatment for osteochondral lesions of the femoral head (OLFH) in young patients.Methods:We performed a 1-year single-arm study and 2 additional years of follow-up of patients with a large (defined as >3 cm2) OLFH treated with insertion of autologous costal cartilage graft (ACCG) to restore femoral head congruity after lesion debridement. Twenty patients ≤40 years old who had substantial hip pain and/or dysfunction after nonoperative treatment were enrolled at a single center. The primary outcome was the change in Harris hip score (HHS) from baseline to 12 months postoperatively. Secondary outcomes included the EuroQol visual analogue scale (EQ VAS), hip joint space width, subchondral integrity on computed tomography scanning, repair tissue status evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and evaluation of cartilage biochemistry by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping.Results:All 20 enrolled patients (31.02 ± 7.19 years old, 8 female and 12 male) completed the initial study and the 2 years of additional follow-up. The HHS improved from 61.89 ± 6.47 at baseline to 89.23 ± 2.62 at 12 months and 94.79 ± 2.72 at 36 months. The EQ VAS increased by 17.00 ± 8.77 at 12 months and by 21.70 ± 7.99 at 36 months (p < 0.001 for both). Complete integration of the ACCG with the bone was observed by 12 months in all 20 patients. The median MOCART score was 85 (interquartile range [IQR], 75 to 95) at 12 months and 75 (IQR, 65 to 85) at the last follow-up (range, 24 to 38 months). The ACCG demonstrated magnetic resonance properties very similar to hyaline cartilage; the median ratio between the relaxation times of the ACCG and recipient cartilage was 0.95 (IQR, 0.90 to 0.99) at 12 months and 0.97 (IQR, 0.92 to 1.00) at the last follow-up.Conclusions:ACCG is a feasible method for improving hip function and quality of life for at least 3 years in young patients who were unsatisfied with nonoperative treatment of an OLFH. Promising long-term outcomes may be possible because of the good integration between the recipient femoral head and the implanted ACCG.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Hip & Pelvis

“…Based on that preclinical study, these authors from Shanghai (China) aimed to assess the potential efficacy, safety, and feasibility of using ACCG for treating large OLFHs. 4 They performed a one-year single-arm study and two additional years of follow-up of patients with a large (defined as > 3 cm 2 ) OLFH treated with insertion of ACCG to restore femoral head congruity after lesion debridement. Overall, 20 patients aged ≤ 40 years who had substantial hip pain and/or dysfunction after nonoperative treatment were enrolled at a single centre.…”

Hip & Pelvis

“…A group from Shanghai (China) described the use of autologous costal cartilage grafting to address large defects. 8 They reported a longitudinal case series of 20 patients, all treated over a single year with two years of follow-up data. Outcomes were assessed with the Harris Hip Score (HHS) and patients had all failed nonoperative treatment prior to inclusion.…”

Autologous Costal Osteochondral Transplantation for Cystic Osteochondral Lesions of the Talus: Feasible and Effective

“…Costa, which has the largest source of hyaline cartilage and can provide both cartilage and corticocancellous bone, might be another ideal and available donor. During the past 30 years, there have been more and more evidence proving the promising results of autologous costal chondral or osteochondral transplantation for articular cartilage repair 6–10 . Moreover, satisfactory clinical outcomes have been observed in fingers, wrist, elbow and knee, from non‐weight‐bearing joints to weight‐bearing joints 6–10 .…”

“…During the past 30 years, there have been more and more evidence proving the promising results of autologous costal chondral or osteochondral transplantation for articular cartilage repair 6–10 . Moreover, satisfactory clinical outcomes have been observed in fingers, wrist, elbow and knee, from non‐weight‐bearing joints to weight‐bearing joints 6–10 . Hasegawa and his colleagues 10 first reported autologous costal osteochondral transplantation (ACOT) for reconstructing proximal interphalangeal articular cartilage defects in 1992.…”

“…In recent years, it has been used in the weight‐bearing joints of the lower extremities. In 2022, Zhang et al 6 . reported a prospective study of autologous costal cartilage graft for osteochondral lesions of the femoral head.…”