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      Simultaneous Osteoperiosteal Autologous Iliac Crest Graft and Lateral Meniscus Allograft Transplantation for Osteochondral Lesion with Bony Defect and Lateral Discoid Meniscus Tear

      case-report
      Author(s): , MD 1 , , MD, PhD 2 , , , MD 3 , , MD 4
      Publication date (Electronic):
      Journal: Knee Surgery & Related Research
      Publisher: The Korean Knee Society
      Keywords: Knee, Meniscus, Cartilage, Autograft, Transplantation

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          Abstract

          The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus.

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          Two- to 9-year outcome after autologous chondrocyte transplantation of the knee.

          L. Peterson, T Minas, M Brittberg … (2000)
          Autologous cultured chondrocyte transplantation was introduced in Sweden in 1987 for the treatment of large (1.5-12.0 cm2) full thickness chondral defects of the knee. The clinical, arthroscopic, and histologic results from the first 101 patients treated using this technique are reported in this study. Patients were assessed retrospectively using three types of endpoints: patient and physician derived clinical rating scales (five validated and two new); arthroscopic assessment of cartilage fill, integration, and surface hardness; and standard histochemical techniques. Ninety-four patients with 2- to 9-years followup were evaluable. Good to excellent clinical results were seen in individual groups as follows: isolated femoral condyle (92%), multiple lesions (67%), osteochondritis dissecans (89%), patella (65%), and femoral condyle with anterior cruciate ligament repair (75%). Arthroscopic findings in 53 evaluated patients showed good repair tissue fill, good adherence to underlying bone, seamless integration with adjacent cartilage, and hardness close to that of the adjacent tissue. Hypertrophic response of the periosteum or graft or both was identified in 26 arthroscopies; seven were symptomatic and resolved after arthroscopic trimming. Graft failure occurred in seven (four of the first 23 and three of the next 78) patients. Histologic analysis of 37 biopsy specimens showed a correlation between hyalinelike tissue (hyaline matrix staining positive for Type II collagen and lacking a fibrous component) and good to excellent clinical results. The good clinical outcomes of autologous chondrocyte transplantation in this study are encouraging, and clinical trials are being done to assess the outcomes versus traditional fibrocartilage repair techniques.
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            A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years.

            Gunnar Knutsen, Jon Drogset, Lars Engebretsen … (2007)
            The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years. Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system. At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years. Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis.
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              Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint.

              Thomas Egelhof, Victor Valderrabano, Geert Pagenstert … (2009)
              Osteochondral lesions are frequently seen in athletes after ankle injuries. At this time, osteochondral autologous transplantation (OATS, mosaicplasty) is the only surgical treatment that replaces the entire osteochondral unit in symptomatic lesions. To evaluate the clinical and radiological midterm to long-term outcome of ankles treated with knee-to-ankle mosaicplasty. Case series; Level of evidence, 4. Clinical evaluation consisted of patient satisfaction, pain evaluation (visual analog scale [VAS]), American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, sports activity score, range of motion, the radiological evaluation of magnetic resonance imaging (MRI), and single photon emission computed tomography-computed tomography (SPECT-CT) analysis of both the ankle and the knee joint. Twelve of 21 patients (mean age, 43 years; male, 8; female, 4) were available for latest follow-up (mean, 72 months). At follow-up, patients reported a satisfaction rate of good to excellent in 92% (n = 11) and poor in 8% (n = 1). The average VAS pain score was 3.9 (preoperative, 5.9; P = .02), AOFAS ankle score significantly increased from 45.9 to 80.2 points (P < .0001), sports activity score remained significantly decreased with 1.25 (preinjury level, 2.3; P = .035), and ankle dorsiflexion was significantly reduced (P = .003). Knee pain was reported in 6 patients (50%). Radiologically, recurrent lesions were found in 10 of 10 cases (100%) and some degree of cartilage degeneration and discontinuity of the subchondral bone plate in 100%. Indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Knee Surg Relat Res
                Journal ID (iso-abbrev): Knee Surg Relat Res
                Journal ID (publisher-id): KSRR
                Title: Knee Surgery & Related Research
                Publisher: The Korean Knee Society
                ISSN (Print): 2234-0726
                ISSN (Electronic): 2234-2451
                Publication date (Print): June 2016
                Publication date (Electronic): 01 June 2016
                Volume: 28
                Issue: 2
                Pages: 165-171
                Affiliations
                [1 ]Department of Orthopedic Surgery, Daejeon Military Hospital, Daejeon, Korea.
                [2 ]Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea.
                [3 ]Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea.
                [4 ]Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Choenan, Korea.
                Author notes
                Correspondence to: Jin Goo Kim, MD, PhD. Department of Orthopedic Surgery, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea. Tel: +82-2-2030-7606, Fax: +82-2-2270-0023, boram107@ 123456hanmail.net
                Article
                DOI: 10.5792/ksrr.2016.28.2.165
                PMC ID: 4895090
                PubMed ID: 27274475
                SO-VID: 7664d5a8-71b6-4004-9b99-8f944a272c0b
                Copyright © Copyright © 2016 KOREAN KNEE SOCIETY
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 September 2015
                Date revision received : 26 October 2015
                Date accepted : 03 November 2015
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: knee,meniscus,cartilage,autograft,transplantation
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: knee, meniscus, cartilage, autograft, transplantation

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