Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes

Abstract

The purpose of this prospective randomized clinical study was to compare the outcomes of mosaic type autologous osteochondral transplantation (OAT) and microfracture (MF) procedures for the treatment of the articular cartilage defects of the knee joint in athletes. Between 1998 and 2002, a total of 57 athletes with a mean age of 24.3 years and with a symptomatic lesion of the articular cartilage in the knee were randomized to undergo either OAT or MF procedure. There were 28 athletes in OAT group and 29 in MF group. Patients were evaluated using a modified Hospital for Special Surgery (HSS) and International Cartilage Repair Society (ICRS) scores, MRI and clinical assessment after 6, 12, 24 and 36 months after the surgery. According to the modified HSS and ICRS scores, functional and objective assessment showed that 96% had excellent or good results after OAT compared with 52% after MF procedure (P<0.001). In 12, 24 and 36 months after the operations, the HSS and ICRS showed statistically significantly better results in the OAT group (P=0.03; P=0.006; P=0.006). Twenty-six (93%) athletes following OAT and fifteen (52%) athletes following MF returned to sports activities at the preinjury level at an average of 6.5 months (range, 4-8 months) after the operations. At an average of 37.1 months follow-up, our prospective, randomized, clinical study in athletes has shown significant superiority of the OAT over MF for the repair of articular cartilage defects in the knee.

Experimental study of influence of direct bisphosphonate administration on bone substitute

“…The reason for these results was considered to be as follows: DDM has been shown to induce the differentiation of undifferentiated mesenchymal cells into osteogenic cells and to induce them to form cartilage and bone [27][28][29][30][31] . Osteogenesis occurs in spaces between DDM particles after implantation, and DDM becomes the core of new bone and promotes its growth, with which DDM is slowly absorbed and replaced with bone through tissue collagenase 20) .…”

Komplexe Gelenkrekonstruktion und Gelenktransplantation mit dem FLOCSAT-Konzept – Planung und chirurgische Umsetzung

“…Hierbei werden die metabolische Aktivität, sowie die extrazelluläre Matrix erhalten, mit dem Ziel der Übertragung eines osteochondralen Konstruktes, welches geometrisch, strukturell und funktionell die geschädigte osteochondrale Gelenkfläche ersetzt. Dabei wird hyaliner Knorpel auf einem Knochengerüst als vitaler Knorpelzellgewebeverbund auf den Empfänger übertragen [13]. Der Knorpel im lateralen Tibiaplateau war von natürlichem Aussehen und wies bei der Untersuchung mit dem Tasthaken eine normale Konsistenz auf.…”

Microfracture of the Knee: Are The Results Achieved In Clinical Practice Statistically Comparable to Those Presented in Controlled Studies?

“…Therefore, in case of diagnosing a cartilage defect, the decision for microfracture could be taken intraoperatively, if it was considered appropriate by the surgeon. Due to missing preselection no exclusion criteria were defined, resulting in a heterogeneous patient population with an average age of 39.7 (15-63) years, an average BMI of 27 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) kg/m² and an average follow-up period of 35 (12-67) months. The cartilage lesions classified as grade 3 or 4 according to Outerbridge had an average size of 216 (39-589) mm².…”