Abstract
Full thickness defects of articular cartilage have a poor capacity for biological repair and often progress to osteoarthritis. Various surgical techniques have been developed to overcome the inability of chondrocytes to heal injured cartilage. Arthroscopic lavage and debridement offer temporary symptomatic relief whereas marrow-stimulating techniques like drilling, microfracture and abrasion arthroplasty yield poor quality fibro-cartilage that is incapable of withstanding the mechanical stresses to which healthy articular cartilage is subjected.
We present our experience using the osteochondral graft transfer technique in the treatment of isolated Outerbridge grade 4 lesions of the knee. The study includes nineteen patients with a mean age of 29 years (range 17 to 40) presenting with symptomatic lesions of the knee with a mean defect size of 2.4cm (0.8 to 6). At a mean follow-up of 20 months (6 to 40) our results showed a significant improvement in patient function by a mean of 46 points or a 23% mean improvement as assessed by the Knee Society Score (P< 0.0001; One sample t-test). Similarly there was significant improvement in the Brittberg scores with a mean improvement by 2 clinical grades (p< 0.0001; Wilcoxon Rank test). Quality of life scores as measured by the Short Form 36 were dramatically improved by a mean of 24 points (p< 0.0001; Wilcoxon Rank test). In addition, there was significant reduction in pain post-operatively (p< 0.0001; Wilcoxon Rank test) with patients describing a mean improvement of 6 points as measured on the visual analogue chart. A significant number of patients (84.2%) were able to return to active sporting levels by 6 months (p< 0.0001;McNemar Change test).
The results of the osteochondral graft transfer technique, at relatively short-term follow-up, are encouraging with a high percentage of subjective satisfaction. This procedure proved to be a reliable and valid solution for treating isolated osteochondral defects of the knee, providing functional and durable cartilage that is critical to joint function.
The abstracts were prepared by Wing Commander T. P. S. Bhullar. Correspondence should be addressed to him at the Ministry of Defence Hospital Unit, Edith Cavell Hospital, Bretton Gate, Peterborough PE3 9GZ.
