Pilot Study of Cartilage Repair in the Knee Joint with Multiply Incised Chondral Allograft

Abstract

BackgroundFocal cartilage lesions in the knee joint have limited capacity to heal. Current animal experiments show that incisions of the deep zone of a cartilage allograft allow acceptable integration for the graft.Questions/PurposesWe performed this clinical study to determine (1) if the multiply incised cartilage graft is surgically applicable for focal cartilage lesions, (2) whether this allograft has a potential to integrate to the repair site, and (3) if patients show clinical improvement.Patients and MethodsSeven patients with 8 chondral lesions were enrolled into the study. Symptomatic lesions between 2 and 8 cm2 were accepted. Additional injuries were allowed but were addressed simultaneously. Grafts were tailored to match and the deep zone of the cartilage was multiply incised to augment the basal integration before securing in place. Rigorous postoperative physiotherapy followed. At 12 and 24 months the patients’ satisfaction were measured and serial magnetic resonance imaging (MRI) was performed in 6 patients.ResultsFollowing the implantations no adverse reaction occurred. MRI evaluation postoperatively showed the graft in place in 5 out of 6 patients. In 1 patient, MRI suggested partial delamination at 1 year and graft degeneration at 2 years. Short Form–36 health survey and the Lysholm knee score demonstrated a significant improvement in the first year; however, by 2 years there was a noticeable drop in the scores. Conclusions. Multiply incised pure chondral allograft used for cartilage repair appears to be a relatively safe method. Further studies are necessary to assess its potential in cartilage repair before its clinical use.

Chondrogenic Effect of Intra‐articular Hypertonic‐Dextrose (Prolotherapy) in Severe Knee Osteoarthritis

“…These outcomes were obtained postprocedure without the use of weight‐reducing devices such as off‐loading braces. Unloading of the knee remains the best care after cartilage repair procedures [25]; therefore, these data may underestimate the potential effect of the procedure in the presence of unloading. The improvement in clinical measures was statistically significant and clinically important, and consistent with 3 open‐label studies and 3 RCTs of hypertonic dextrose prolotherapy injections for the knee OA [4‐9].…”

Current Applications of Growth Factors for Knee Cartilage Repair and Osteoarthritis Treatment

“…Many factors have been suspected for the limited potential of vertical and horizontal integration of the peripheral healthy cartilage into the repair tissue. Chondrocyte immobility in the extracellular matrix has been speculated to be a significant limiting factor in the repair capacity [18], but chondrocytes are motile and can move through the extracellular matrix once adequate signals are present [19]. Incision through the cartilage tissue has been shown to induce chondrocyte motility producing neocartilage around the edges [20•].…”

Internal Fixation of Osteochondritis Dissecans Lesions in the Patellofemoral Joint

“…Also, there are animal and human reports of cartilage-only healing reported by Bardos et al who used linear incisions made on the basilar side of cartilage-only allograft ("hedgehog" graft prep), which demonstrated healing. 34,35 The technique offered remains open for refinement.…”