Osteochondral Autograft Transfer Procedure: Arthroscopic Technique and Technical Pearls

Abstract

The Osteochondral Autograft Transfer System (OATS; Arthrex, Naples, FL) is an excellent option for the treatment of articular cartilage lesions within the knee. Current literature suggests that at early-term to midterm follow-up, patients experience improved function, alleviation of pain, and good satisfaction with acceptable complication rates. Although long-term data are lacking, studies in athletes have shown that the OATS can provide an adequate rate of return to sports. The OATS procedure has traditionally been considered an open procedure. However, with the advancement of arthroscopic techniques, the procedure can now be completed arthroscopically. We discuss this modern operation.

Small Cartilage Defect Management

“…1 Indications include patients < 50 years old who have failed conservative treatment for small to intermediate cartilage defects. 1,9 It is generally accepted that OAT is the best performed on small cartilage defects. 1,8 OAT can also be used to fill osteochondral defects, including small-osteochondritis dissecans lesions, because the subchondral bone is still attached to the donor plug.…”

“…1 OAT can be performed open or arthroscopically, with the latter being more technically challenging. 9 The defect is first visualized arthroscopically and measured carefully because the size of the defect helps to determine if the procedure should be done arthroscopically or open. 8,9,32 The defect site is carefully debrided down to bleeding bone and until healthy margins are created.…”

“…9 The defect is first visualized arthroscopically and measured carefully because the size of the defect helps to determine if the procedure should be done arthroscopically or open. 8,9,32 The defect site is carefully debrided down to bleeding bone and until healthy margins are created. 32,36 Next, an appropriate graft must be chosen.…”

“…OAT is technically challenging to perform and requires significant buy-in from patients because, of the 6-month recovery period. 8,9 The size of the cartilage defect is an important limitation for OAT. Larger defects have a high risk of significant donor site morbidity.…”

“…It is important to also address limb malalignment, ligament deficiency, and meniscal injuries to ensure joint stability and prevent overload. 1,9 The recovery time for the various cartilage restoration procedures vary, but all require prolonged rehabilitation and motivation from patients. 1 It is important to preoperatively assess a patient's willingness to comply with any postoperative restrictions, as well as optimize a patient's healing potential by abstaining from nicotine both pre-and postoperatively.…”