Sandwich Technique for Large Osteochondral Lesions of the Knee

Abstract

Objective To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years. Design Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Results Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up ( P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant ( P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months ( P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months ( P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up ( P < 0.05) but did not correlate with clinical scores or defect filling. Conclusion MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients’ activity levels remain low, even 2 years after surgery.

The role of autologous bone grafting in matrix‐associated autologous chondrocyte implantation at the knee: Results from the German Cartilage Registry (KnorpelRegister DGOU)

“…Therefore, confusion with the ICRS OCD classification, mislabelling or other reasons for concomitant bone grafting may In addition, the study population has insufficient baseline MRI data and no follow-up MRI data for analysis. This is unfortunate because it misses the opportunity to examine for the first time MRI data from a substantial cohort undergoing M-ACI and additional ABG [13,14]. Recently, a correlation between subchondral bone parameters, cartilage MRI signal and outcome after CR has been suggested [14].…”

“…However, more recent studies also show good results for the combination of ABG and M-ACI in both clinical and radiological follow-up [13,21,40]. However, the results of these studies are limited by their small sample sizes and lack of control groups.…”

Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee

“…Of clinical relevance, this study provides a differentiated analysis of anatomic joint characteristics, which may be of clinical relevance when planning a potential alignment corrective osteotomy in the treatment of OCD to improve the survival of a concomitant cartilage therapy. 16 , 19 , 26 …”

Satisfactory patient‐reported outcomes in patients treated with impaction bone grafting and autologous matrix‐induced chondrogenesis for osteochondral knee defects

“…After that, a second membrane is sutured on the articular surface and the autologous cultured chondrocytes are injected between the two collagen membranes, giving the “sandwich” name to the technique [23, 25]. Alternatively, a single 3D collagen matrix containing the in vitro proliferated chondrocytes can be used [13]. The sandwich technique has shown to be superior to autologous bone grafting alone, and significantly improved the Cincinati, WOMAC and SF‐36 scores in the study of Minas et al in the long‐term [23].…”