Abstract
Purpose: The aim of this study is the mid-term analysis of osteochondral autograft transplantation for the repair of focal femoral defects.
Methods: We present clinical data based on arthroscopic and MRI appearances of 18 patients, from 2 to 6 years postoperatively, which illustrate growing concern about the progressive deterioration of articular cartilage surrounding the OAT graft. It seems that the osteochondral autograft transfer (OAT) can restore the height and the shape of articulating surface in osteochondral defects with composite autologous material that contains hyaline articular cartilage and a firm carrier. However, limited availability of autologous osteochondral grafts, dead spaces between circular grafts, the lack of integration of donor and recipient hyaline cartilage, and different thickness and mechanical properties of donor and recipient hyaline cartilage are frequent sources of clinical concern.
Results: Typically, the OAT graft itself maintains its mechanical and histological integrity over the years, but surrounding articular cartilage continues to deteriorate, leading to a wide area of further chondral damage. Although this is difficult to understand and explain, it seems that the damage to articular cartilage surrounding the defect, and probably most importantly the lack of chondral integration, are the main reason for further chondral damage.
Conclusion: Adherence to clear indications, correction of concomitant pathology, precise surgical technique and realistic goals are most important when considering OAT surgery in symptomatic patients with femoral osteochondral lesions. Treatment of focal femoral chondral lesions in active individuals remains a significant challenge with many controversies remaining.
The abstracts were prepared by Mr Roger Smith. Correspondence should be addressed to him at the British Association for Surgery of the Knee, c/o BOA, Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields, London WC2A 3PN.
