Abstract
Articular defects in the knee can be managed by surface treatments, cartilage cell transplantation, periosteal grafts, osteochondral autografts, and osteochondral allografts. The factors, which determine the most appropriate treatment, are the size of the defect, and the associated bone loss. If there is an associated deformity, all of the aforementioned techniques would be combined with osteotomy.
Chondral defects with no significant bone involvement can be managed arthroscopically by surface treatments like debridement and drilling, abrasion arthroplasty, and microfracture. Chondral defects can also be managed arthroscopically by osteochondral autografts (mosaicplasty) or by cartilage cell transplant or periosteal grafts, both of which are done by open surgery. The arthroscopic surface treatments are best reserved for small defects but cell transplantation and mosaicplasty have been used for defects up to 2 cm in diameter. Periosteal grafting can be used for large defects affecting an entire condyle, but clinical experience with this procedure is limited and it is still considered experimental.
Articular defects that involve bone can to some degree be treated by mosaicplasty if the bone defect is contained and less than 1 cm in depth.
Larger osteochondral defects are managed by osteochondral allografts (uncontained defects greater than 3 cm in diameter and greater than 1 cm in depth). The disadvantage of osteochondral allografting is that it requires an open procedure and there is the potential for disease transmission.
The author has published a series of 126 knees in 123 patients with major post-traumatic osteochondral defects treated by allografts. At an average follow-up of 7.5 years the success rate was 85%. Retrieval studies have confirmed hyaline cartilage.
In a recent study of 40 patients with femoral condylar grafts for trauma or osteochondritis dissecans, at an average follow-up of 11 years, the survivorship was 80%.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
