CHONDRAL TRANSPLANT IN KNEE OSTEOARTHRITIS

Abstract

Osteoarthritis is the end stage of a gradual process of degradation of the cartilage and secondary responses in other tissues within a joint after many years of use. It is common in the knee joints in elderly. The surgical treatments for OA are often symptomatic, such as arthroplasty and HTO. Traumas to the knee, especially in combination with other injuries such as ACL rupture or meniscal tears, can lead to a speedy process and premature OA. The osteoarthritic patient often experiences a gradual on set of symptoms such as pain and swelling on weight bearing, catching and locking and in late stage nightly pains, leading to a very limited lifestyle. If it is possible to treat the OA at an early stage and thus hindering the destruction of the joint, much is won for the patient.

Autologous chondrocyte transplantation (ACT) is a treatment for focal chondral and osteochondral lesions in the knee joint. The technique has also been used on patients with early stages of OA in knee, including multiple lesions, kissing lesions, lesions in combination with malalignment, instability and total mensicectomy. When treating these patients it is important to not only focus on the cartilage lesions but also on other pathology. A high tibial osteotomy should be considered, especially if there is a malalignment, but also as an unloading procedure if the lesion is large or if there are bipolar kissing lesions. If the patient has had total or subtotal meniscectomy meniscal allograft transplantation may be indicated. Ligamentous instability from a ruptured ACL for example must also be treated. All these procedures can be done prior to or after the ACT, but mostly concomitant with the ACT. As the patients have often been symptomatic for a long time and the greater surgical trauma with a concomitant procedure, it is harder to regain knee function after the surgery. Close contact between the patient, the doctor and the physical therapist is imperative, so measures can be taken if the patient does not progress accordingly.

Young patients with early OA are hard cases. These patients often have a high demand on knee function and have had a high level of activity but are disabled by their symptoms. When treating these patients with ACT it is important to assess and treat all pathology that may jeopardize a good outcome.