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

Abstract

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.

Treatment of Patellofemoral Chondral Lesions Using Microfractures Associated with a Chitosan Scaffold: Mid-Term Clinical and Radiological Results

“…18 found out in their series of patellofemoral chondral lesions treated with autologous chondrocyte implantation (ACI), improvements in all areas of the KOOS (Knee Injury and Osteoarthritis Outcome Score) questionnaire at 2 years. Similarly, Figueroa et al ., 19 in a series of patellofemoral chondral lesions treated using osteochondral autograft transplantation (OAT) found promising results in the Kujala and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores. It is important to remark, that unlike ACI, OAT has a size limitation because of donor-site morbidity.…”

Bilateral osteochondral defects of the patellae in an 11-year-old girl

“…[19][20][21][22][23] If symptoms remain refractory to these interventions and/or the OCDs progress to late stage, recent studies demonstrating satisfying functional results with autologous osteochondral mosaicplasty and matrix-assisted chondrocyte implantation (MACI) provide hopeful alternative options in young patients. [42][43][44][45] Our preferred surgical treatment if nonoperative management had failed, especially for the unstable lesion in the right knee, would have been diagnostic arthroscopy followed by fixation of the OCD with bioabsorbable chondral darts or restoration with osteochondral autograft. However, dependent on intraoperative findings, fixation would have been the initial surgical management of choice by our senior authors.…”

Therapie patellofemoraler Knorpelschäden

“…Sie wird bevorzugt bei kleinen osteochondralen Defekten (< 2 cm²) eingesetzt. Hierbei gibt es die Möglichkeit der autologen und allogenen Transplantation mit guten klinischen und radiologischen Ergebnissen im Follow-up 38 39 . Wichtig ist, hierbei jedoch die hohe Entnahmemorbidität zu beachten.…”