gms | German Medical Science

Objectives: Large osteochondral defects of the knee are still a challenge for regenerative treatment. Especially the remodeling of the subchondral plate is crucial for successful treatment of osteochondral lesions. While matrix guided autologous chondrocyte transplantation (MACT) represents an appropriate option to treat the chondral part of the osteochondral defect the best treatment for bone augmentation is still inconclusive.

In this study a new bone block augmentation technique combined with chondrocyte transplantation for treatment of large osteochondral defects of the knee is described and the 1 to 3 years clinical and radiological outcome of this new technique is analyzed.

Methods: 51 patients (22 women, 29 men; mean age: 28 years) treated for osteochondral lesions (mean defect size, 6,4 cm2) with MACT and bone block augmentation were followed at 3, 6 months, 1, 2 and 3 years and clinically evaluated using the International Knee Documentation Committee (IKDC) score and the Cincinnati score. An MRI evaluation was performed at 3 months 1, 2 and 3 years, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score with specific subchondral bone parameters (bone regeneration, bone signal quality, osteophytes, sclerotic areas, and edema) were analyzed.

Results and Conclusion: The preoperative status of the patients showed IKDC scores in the mean of 42 (18-72). Postoperative IKDC scores increased significantly in the first year to mean scores of 82 points (48-100). To the 3 years follow-up, subsequent increase can be detected to mean scores of 90 (62-98). A significant increase in MOCART scores could be detected with time in all subgroups by 3 blinded reviewers. No operative revision was needed, no implant failure could be seen.

In conclusion large osteochondral defects of the knee can successfully be treated with new bone block augmentation technique combined with autologous chondrocyte transplantation.