gms | German Medical Science

Objectives: For reconstruction of large osteochondral lesions of the knee or the talus osteochondral autologous grafts are a well-known opportunity. Grafts are taken normally from the ipsilateral patella groove or the dorsal condyles.

We propose that for a good to excellent clinical result, donor-site reconstruction should be done as careful as the transplantation itself.

Methods: Between 2009-2014 fifty patients (14-74y) with osteochondral defects received knee reconstructions and forty-eight talus reconstructions.

Femoral condyles were reconstructed with double-cylinders, triple-cylinder-chains or even four overlapping cylinders. Average cylinder-calibre was 12,85mm.

Osteochondral defects of the ankle were reconstructed with double-transplants or triple-cylinder chains. Average cylinder-calibre was 10,60mm.

Surgery was performed with autologous grafts from the ipsilateral patella groove. Press-fit tricalcium-phosphate cylinders were used to fill the cancellous defect. The joint surface was covered with fibro-osseous press-fit plugs taken from the iliac crest containing musculoskeletal fibres. The iliac crest defects were filled press-fit with hydroxyapatite bone graft cylinders.

Clinical evaluation pre- and 2 years postoperatively consisted of pain evaluation (Visual Analog Scale (VAS)), American Orthopedic Ankle score (AOAS) or Tegner-Lysholm score (TLS), Modified Cincinnati Score (MCS) and Knee Society score (KSS).

Results: VAS, TLS, KSS and MCS showed in the knee and ankle patient groups a significant improvement (p=.001, Student T-Test) for all four scores. Knee: VAS (preoperative 5,94, 2y postoperative 0,57); TLS (58,39 -> 95,29); KSS (67,58 -> 95,33); MCS (55,55 -> 94,21) Ankle: VAS (6,39 -> 0,34); AOAS (59,6 -> 97,7). Intergroup analysis for single, double and triple cylinder reconstructions itself showed no decline in results.

87 patients reported no donor-site morbidity 6 weeks postoperatively. 11 patients exhibited prolonged femoral donor-site morbidity up to 3 months. There was no loosening at the reconstructed donor-site area in all cases. At the iliac crest HA-graft integration was detected in all cases. One Patient was suffering from an irritation of the nervus cutaneous femoris lateralis, due to irregular location of the nerve.

Conclusion: Large osteochondral defects can be reconstructed by using a precise operating technique with diamond milling cutters. Careful reconstruction of the donor-site may contribute significantly to the positive outcomes.