Osteochondral autologous transplantation yielded significantly improved results
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According to study results, osteochondral autologous transplantation is a safe and reliable procedure for treatment of high-grade osteochondral defects in the patella and resulted in significant improvements in patient-reported outcomes and return to sports.
“[Osteochondral autologous transplantation] OAT should be offered to patients with high-grade patellar chondral defects when nonoperative management has not proven successful in managing anterior knee symptoms,” the authors wrote.
Researchers performed a systematic review and identified five studies with a total of 102 patients who underwent OAT for the treatment of isolated patellar cartilage high-grade defects. These studies addressed patient-reported outcomes, return to sports and MRI at follow-up after OAT.
Results showed all patients outcomes improved significantly at the final follow-up based on the Lysholm, International Knee Documentation Committee, Kujala, Tegner, and SF-36 scores. Of the five studies, four studies had MRIs performed during the first year postoperatively to evaluate the osteochondral plug integration and positioning. Investigators noted that at the final follow-up, most of the plugs were integrated and positioned correctly. There were two studies that queried whether patients were able to return to sports and these showed that in most cases, patients were able to return to their previous level of sport. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Miho J. Tanaka, MD
Donoso et al performed a systematic review on the results of osteochondral autologous transplantation (OAT) procedures for the treatment of isolated, high-grade patellar cartilage defects. Five studies were included with a total of 102 patients who underwent OAT procedures for patellar chondral defect (ICRS grade 3-4), with a follow up period ranging 12 months to 57 months. The authors noted significant improvement based on reported Lysholm, IKDC, Kujala, Tegner and SF-36 scores. In four studies, osteochondral plugs were found to have integrated on MRI at a rate of 60% to 100% ranging 6 months to 24 months postoperatively. Return to sports was reported in two studies, with one reporting no limitations based on questioning with non-validated measures, and another reporting Tegner activity scale ranging 5 to 9 at 24 months.
The authors included studies that were related to the management of patellar OAT procedures, with ICRS grade 3-4 lesions, with or without MPFL reconstruction. While the overall summarized results reflect good short and midterm functional and imaging outcomes in the treatment of high grade patellar chondral defects with OATs, the role of patellar instability in these cases needs further elucidation. Heterogeneity was noted in the studies in terms of lesion size and location, as well as in follow up. Future consensus on follow up measures and timing may allow for a more detailed understanding of the factors that influence outcomes in cartilage procedures for the patellofemoral joint.
Massachusetts General Hospital
Boston
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