The Journal of Bone and Joint Surgery (American) 85:17-24 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Treatment of Osteochondritis Dissecans of the Knee with Autologous Chondrocyte Transplantation
Results at Two to Ten Years
Lars Peterson, MD, PhD,
Tom Minas, MD,
Mats Brittberg, MD, PhD and
Anders Lindahl, MD, PhD
Lars Peterson, MD, PhD
Mats Brittberg, MD, PhD
Anders Lindahl, MD, PhD
Institutions for Orthopaedics (L.P. and M.B.) and Laboratory Medicine (A.L.), Gothenburg University, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden
Tom Minas, MD
Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Swedish Medical Research Council (M.B. and A.L.). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: Osteochondritis dissecans of the knee is a challenging clinical problem. We previously reported on the early successful results of autologous chondrocyte transplantation for the treatment of focal cartilage defects. The purpose of the present study was to assess the intermediate to long-term results of this technique in a large group of patients with osteochondritis dissecans.
Methods: Fifty-eight patients with radiographically documented osteochondritis dissecans of the knee underwent treatment with autologous chondrocyte transplantation between 1987 and 2000 and were assessed clinically with use of standard rating scales. Twenty-two patients consented to arthroscopic second-look evaluation of graft integrity.
Results: The mean age of the patients at the time of autologous chondrocyte transplantation was 26.4 years (range, fourteen to fifty-two years). Seven patients were less than eighteen years old. Thirty-five patients (60%) had juvenile-onset disease, and forty-eight patients (83%) had had a mean of 2.1 prior operations. The defect was located on the medial femoral condyle in thirty-nine patients and on the lateral femoral condyle in nineteen. The mean lesion size was 5.7 cm
2 (range, 1.5 to 12.0 cm
2 ), and the mean defect depth was 7.8 mm (range, 4 to 15 mm). After a mean duration of follow-up of 5.6 years, 91% of the patients had a good or excellent overall rating on the basis of a clinician evaluation and 93% had improvement on a patient self-assessment questionnaire. The Tegner-Wallgren, Lysholm, and Brittberg-Peterson VAS scores were all improved. The macroscopic quality of graft integrity averaged 11.2 on a 12-point scale, with only one graft having a score of <9 points. Two patients had a failure of treatment in the early postoperative period. Only one patient who had had a good or excellent rating at two years had a decline in clinical status at the time of the latest follow-up.
Conclusions: Treatment of osteochondritis dissecans lesions of the knee with autologous chondrocyte transplantation produces an integrated repair tissue with a successful clinical result in >90% of patients. We recommend the wider use of autologous chondrocyte transplantation for this condition.
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