Functional outcomes after patellar autologous osteochondral transplantation

Astur, Diego Costa; Bernardes, Adilio de Paula; Castro, Saulo; Arliani, Gustavo Gonçalves; Kaleka, Camila Cohen; Astur, Nelson; Cohen, Moisés

doi:10.1007/s00167-016-4108-z

Cited by 20 publications

(27 citation statements)

References 44 publications

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“…In this regard, other recent studies have analyzed the same outcomes and revealed that most plugs (67%-100%, depending on the analyzed series) remained flush with surrounding native articular cartilage, with full osteochondral integration at 12 months of follow-up. 2,3,11,22 These findings follow the same line as recent published literature. Cohen et al 7 evaluated a series of 17 patients treated with OAT for a patellar chondral defect, reporting significant improvements in functional assessments including Lysholm, Kujala, Fulkerson, and 36-Item Short Form Health Survey scores.…”

Section: Discussionsupporting

confidence: 91%

“…The Tegner sports scale revealed a preoperative score range of 0 to 5, which increased to 5 to 9 at 2 years of follow-up. 3,11 A recent systematic review that aimed to assess patellar OAT outcomes arrived at a similar conclusion. 8 Patients showed significant improvement in patient-reported outcomes at final follow-up, with most of them being able to return to previous levels of sports activities (Tegner score range, 5-9 at 2 years of follow-up).…”

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts

Figueroa

Rodríguez

Donoso

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects. Purpose: To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm2. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up. Results: A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm2 (range, 64-250 mm2), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points). Conclusion: To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 79%

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High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts

Figueroa

Rodríguez

Donoso

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…9 Existen varias publicaciones que, al igual que nuestro estudio, avalan el trasplante osteocondral autólogo en la rótula con buenos resultados funcionales a corto, mediano y largo plazo. 3,5,6,8,10,11,12 Figueroa y colaboradores realizan un estudio prospectivo con un seguimiento medio de tres años, que incluye 10 pacientes con lesiones osteocondrales patelares grado IV de ICRS, tratados con trasplante osteocondral autólogo y encuentran una mejora estadísticamente significativa de la escala Lysholm, con 100% de resultados satisfactorios, 60% buenos y 40% excelentes. 12,13 Nuestro estudio muestra una mejora subjetiva de la función y el dolor con un incremento significativo de la escala funcional Kujala y de la puntuación EVA a mediano plazo.…”

Section: Discussionunclassified

“…No se autoriza correr hasta el cuarto mes y los deportes de alta demanda funcional se reinician a partir del sexto mes. 8 La recopilación de datos se realiza mediante revisión de las historias clínicas a través del soporte informático. Las variables recogidas fueron edad, sexo, fecha de la intervención, tamaño de la lesión, faceta afectada, número de cilindros trasplantados, escala de Kujala pre y postoperatoria y escala visual analógica del dolor (EVA) pre y postoperatoria.…”

Section: Materials Y Métodosunclassified