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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-10-2017 | Knee

Functional outcomes after patellar autologous osteochondral transplantation

Authors: Diego Costa Astur, Adilio Bernardes, Saulo Castro, Gustavo Gonçalves Arliani, Camila Cohen Kaleka, Nelson Astur, Moisés Cohen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2017

Abstract

Purpose

The aim of the present study was to assess clinical evaluation of patients who underwent autologous osteochondral transplantation of the patella.

Methods

This prospective study assessed outcomes of 20 patients who underwent patellar autologous osteochondral transplantation at four time-points: preoperatively, 3 days, 6 months, and 2 years after surgery. The following outcomes were assessed at each time-point: pain (VAS), gait, swelling, trophic status, muscle strength, patellar mobility, and range of motion. The Tegner scale was also applied for each time-point.

Results

All parameters improved, except for patellar mobility, which did not show any change. Pain score decreased from 7.1 (SD 2.3) to 2.4 (SD 2.6) at the 2-year assessment; limping decreased from 70 % before surgery to 15 % 2 years later; swelling scores decreased from an average of 1.8 (SD 0.8) 3 days after surgery to 0.5 (SD 0.7) at the 2-year assessment; muscle strength increased from 3.9 (SD 0.8) to 4.7 (SD 0.7) points at final follow-up; and the range of motion increased from 84 (SD 16.2) to 132 (SD 10.7) degrees 2 years later. Tegner score before surgery ranged from 0 to 5, and after 2 years, it ranged from 5 to 9.

Conclusion

Autologous osteochondral transplantation for the treatment of patellar chondral lesion was associated with significant improvement in pain, gait, swelling, and range of motion 2 years after surgery, achieving scores similar to uninjured knees. Most of them were able to return to sports activity after 6 months (recreational level) and 2 years (competitive level).

Level of evidence

IV.

Astur DC, Arliani GG, Binz M, Astur N, Kaleka CC, Amaro JT, Pochini A, Cohen M (2014) Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a 2-year follow-up study. J Bone Joint Surg Am 96(10):816–823CrossRefPubMed

Astur DC, Gracitelli GC, Arliani GG, Astur N, Kaleka CC, Pochini A, Cohen M (2014) Autologous Osteochondral Transplantation to Treat Patellar Chondral Injuries. J Bone Joint Surg Essent Surg Tech 4(3):e17CrossRef

Bentley G, Biant LC, Carrington RW, Akmal M, Goldberg A, Williams AM (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 85:223–230CrossRefPubMed

Bobic V (1996) Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc 3(4):262–264CrossRefPubMed

Brix MO, Stelzeneder D, Chiari C, Koller U, Nehrer S, Dorotka R, Windhager R, Domayer SE (2014) Treatment of full-thickness chondral defects with hyalograft C in the knee: long-term results. Am J Sports Med 42(6):1426–1432CrossRefPubMed

Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 34(2):305–309CrossRefPubMedPubMedCentral

Chow JC, Hantes ME, Houle JB, Zalavras CG (2004) Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study. Arthroscopy 20:681–690CrossRefPubMed

Collado H, Fredericson M (2010) Patellofemoral pain syndrome. Clin Sports Med 29:379–398CrossRefPubMed

Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460CrossRefPubMed

10.

Farr J, Jaggers R, Lewis H, Plackis A, Sim SB, Sherman SL (2014) Evidence-based approach of treatment options for postoperative knee pain. Phys Sports Med 42(2):58–70CrossRef

11.

Figueroa D, Meléan P, Calvo R, Gili F, Zilleruelo N, Vaisman A (2011) Osteochondral autografts in full thickness patella cartilage lesions. Knee 18(4):220–223CrossRefPubMed

12.

Filardo G, Kon E, Di Matteo B, Di Martino A, Marcacci M (2014) Single-plug autologous osteochondral transplantation: results at minimum 16 years’ follow-up. Orthopedics 37(9):e761–e767CrossRefPubMed

13.

Filardo G, Kon E, Perdisa F, Balboni F, Marcacci M (2014) Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at 2 years’ follow-up. Int Orthop 38(9):1905–1912CrossRefPubMed

14.

Fraser EJ, Harris MC, Prado MP, Kennedy JG (2015) Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3606-8 PubMed

15.

Goutallier D, Bernageau J, Lecudonnec B (1978) Mesure de l’écart tubérosité tibiale antérieure-gorge de la trochlée (TA.GT). Technique Résultats Intérêts. Rev Chir Orthop Reparatrice Appar Mot 64(5):423–428PubMed

16.

Grelsamer RP, Stein DA (2006) Patellofemoral arthritis. J Bone Joint Surg Am 88:1849–1860PubMed

17.

Gudas R, Kalesinskas RJ, Kimtys V, Stankevicius E, Toliusis V, Bernotavicius G, Smailys A (2005) A prospective randomized clinical study of mosaic osteochondral autologous transplant versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy 21:1066–1075CrossRefPubMed

18.

Hangody L, Füles P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: 10 years of experimental and clinical experience. J Bone Joint Surg Am 85(2):25–32CrossRefPubMed

19.

Hangody L, Kish G, Kárpáti Z, Szerb I, Udvarhelyi I (1997) Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc 5(4):262–267CrossRefPubMed

20.

Hollanda JPB, Ferretti M, QuarteiroML Amaro JT, Cohen M (2010) Transplante osteocondral autólogo no tratamento de lesões osteocondrais em atletas. Acta Ortop Bras 18(6):349–352CrossRef

21.

Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104CrossRefPubMed

22.

Jensen MP, Chen C, Brugger AM (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 4(7):407–414CrossRefPubMed

23.

Kendall FP, McCreary EK, Provance PG, Rod MM (2007) Músculos Provas e Funções, com postura e dor. Manole, São Paulo

24.

Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163CrossRefPubMed

25.

Lee KB, Bai LB, Yoon TR, Jung ST, Seon JK (2009) Second-look arthroscopic findings and clinical outcomes after microfracture for osteochondral lesions of the talus. Am J Sports Med 37(Suppl 1):63S–70SCrossRefPubMed

26.

Lynch TS, Patel RM, Benedick A, Amin NH, Jones MH, Miniaci A (2015) Systematic review of autogenous osteochondral transplant outcomes. Arthroscopy 31(4):746–754CrossRefPubMed

27.

Mainil-Varlet P, Aigner T, Brittberg M, Bullough P, Hollander A, Hunziker E, Kandel R, Nehrer S, Pritzker K, Roberts S, Stauffer E (2003) Histological assessment of cartilage repair: a report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS). J Bone Joint Surg Am 85(Suppl 2):45–57CrossRefPubMed

28.

Marcacci M, Kon E, Zaffagnini S, Iacono F, Neri MP, Vascellari A, Visani A, Russo A (2005) Multiple osteochondral arthroscopic grafting (mosaicplasty) for cartilage defects of the knee: prospective study results at 2-year follow-up. Arthroscopy 21(4):462–470CrossRefPubMed

29.

Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56(7):1391–1396CrossRefPubMed

30.

Mor A, Grijota M, Nørgaard M, Munthe J, Lind M, Déruaz A, Pedersen AB (2015) Trends in arthroscopy-documented cartilage injuries of the knee and repair procedures among 15–60-year-old patients. Scand J Med Sci Sports 25(4):e400–e407CrossRefPubMed

31.

Neto OAL, Franciozi CES, Júnior GSMG, Queiroz AAB, Filho MC, Navarro RD (2010) Tratamento cirúrgico das lesões osteocondrais do joelho com mosaicoplastias. Rev Bras Ortop 45(2):166–173CrossRef

32.

Nett MP, Pedersen HB, Roehrig GJ, Tria AJ, Scott WN (2012) Insall e Scott, Surgery of the knee, 5th ed. Elsevier, New York, pp 47–60

33.

Nho SJ, Foo LF, Green DM, Shindle MK, Warren RF, Wickiewicz TL, Potter HG, Williams RJ (2008) Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am J Sports Med 36(6):1101–1109CrossRefPubMed

34.

Quinn TM, Häuselmann HJ, Shintani N, Hunziker EB (2013) Cell and matrix morphology in articular cartilage from adult human knee and ankle joints suggests depth-associated adaptations to biomechanical and anatomical roles. Osteoarthritis Cartilage 21(12):1904–1912CrossRefPubMed

35.

Quinn TM, Hunziker EB, Häuselmann HJ (2005) Variation of cell and matrix morphologies in articular cartilage among locations in the adult human knee. Osteoarthritis Cartilage 13(8):672–678CrossRefPubMed

36.

Rasch A, Dalén N, Berg HE (2005) Test methods to detect hip and knee muscle weakness and gait disturbance in patients with hip osteoarthritis. Arch Phys Med Rehabil 86(12):2371–2376CrossRefPubMed

37.

Steadman JR, Briggs KK, Matheny LM, Guillet A, Hanson CM, Willimon SC (2015) Outcomes following microfracture of full-thickness articular cartilage lesions of the knee in adolescent patients. J Knee Surg 28(2):145–150PubMed

38.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

39.

Unay K, Akcal MA, Gokcen B, Akan K, Esenkaya I, Poyanlı O (2014) The relationship between intra-articular meniscal, chondral, and ACL lesions: finding from 1774 knee arthroscopy patients and evaluation by gender. Eur J Orthop Surg Traumatol 24(7):1255–1262CrossRefPubMed

40.

Van Assche D, Staes F, Van Caspel D, Vaniauwe J, Bellemans J, Saris DB, Luyten FP (2010) Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 18:486–495CrossRefPubMed

41.

Wagner H (1964) Surgical treatment of osteochondritis dissecans, a cause of arthritis deformans of the knee. Rev Chir Orthop Reparatrice Appar Mot 50:335–352PubMed

42.

Widuchowski W, Widuchowski J, Faltus R, Lukasik P, Kwiatkowski G, Szyluk K, Koczy B (2011) Long term clinical and radiological assessment of untreated severe cartilage damage in the knee: a natural history study. Scand J Med Sci Sports 21(1):106–110CrossRefPubMed

43.

Zak L, Krusche-Mandl I, Aldrian S, Trattnig S, Marlovits S (2014) Clinical and MRI evaluation of medium- to long-term results after autologous osteochondral transplantation (OCT) in the knee joint. Knee Surg Sports Traumatol Arthrosc 22(6):1288–1297CrossRefPubMed

Title: Functional outcomes after patellar autologous osteochondral transplantation
Authors: Diego Costa Astur
Adilio Bernardes
Saulo Castro
Gustavo Gonçalves Arliani
Camila Cohen Kaleka
Nelson Astur
Moisés Cohen
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4108-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Functional outcomes after patellar autologous osteochondral transplantation

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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