Universidad del Desarrollo

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High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts
(2020)
FIGUEROA POBLETE, DAVID HUMBERTO
;
CALVO RODRIGUEZ, RAFAEL
;
Rodrigo Donoso
;
Jaime Espinoza
;
Alex Vaisman
<jats:sec><jats:title>Background:</jats:title><jats:p>Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects.</jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p>To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects.</jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p>Case series; Level of evidence, 4.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm<jats:sup>2</jats:sup>. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm<jats:sup>2</jats:sup>(range, 64-250 mm<jats:sup>2</jats:sup>), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points).</jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.</jats:p></jats:sec>
Scopus© Citations 11 1
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Osteochondral Autologous Transplantation for Treating Patellar High-Grade Chondral Defects: A Systematic Review
(2019)
Rodrigo Donoso
;
DAVID HUMBERTO FIGUEROA POBLETE
;
Jaime Espinoza
;
Claudio Yañez
;
Jamil Saavedra
<jats:sec><jats:title>Background:</jats:title><jats:p>Patellar cartilage defects account for 34.6% of defects found during routine arthroscopy. These defects pose a challenge in orthopaedic surgery because they have been associated with worse outcomes after surgical repair compared with other chondral lesions within the knee.</jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p>To systematically review the literature for evidence on results of osteochondral autologous transplantation (OAT) for the management of isolated patellar cartilage high-grade defects (International Cartilage Repair Society [ICRS] grade 3-4).</jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p>Systematic review; Level of evidence, 4.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>A systematic review of the literature was performed to find studies that addressed outcomes regarding OAT to treat patellar high-grade cartilage defects (ICRS grade 3-4). Studies addressing patient-reported outcomes, return to sports, or magnetic resonance imaging (MRI) at follow-up after isolated OAT procedures for patellar cartilage defects were included.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>A total of 5 studies were included in this review. We were not able to perform a meta-analysis as no studies had available data. A total of 102 patients who received an isolated OAT for a patellar chondral defect were included in these 5 studies. All patients showed significant improvement at final follow-up based on the following patient-reported outcome scores: Lysholm, International Knee Documentation Committee, Kujala, Tegner, and 36-Item Short Form Health Survey. We found that 4 studies used MRI during the first postoperative year to assess osteochondral plug integration and positioning. The results demonstrated that most plugs were integrated and correctly positioned when evaluated at follow-up, conducted on average after 12 months. Whether patients were able to return to sports was queried in 2 of the included studies, revealing that patients could return to their previous level in most cases (Tegner score, 5-9 at 2 years after surgery).</jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>Results indicate that OAT is a safe and reliable technique to treat patellar high-grade osteochondral defects, allowing for significant improvement in patient-reported outcomes and return to sports.</jats:p></jats:sec>
1Scopus© Citations 24

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