Matrix‐assisted chondrocyte transplantation with bone grafting for knee osteochondritis dissecans: stable results at 12 years
Luca Andriolo, Alessandro Di Martino, Sante Alessandro Altamura, Angelo Boffa, Alberto Poggi, Maurizio Busacca, Stefano Zaffagnini, Giuseppe Filardo
Abstract
Abstract Purpose To document clinical and radiological results of arthroscopic matrix‐assisted autologous chondrocyte transplantation (MACT) combined with bone grafting for the treatment of knee osteochondritis dissecans (OCD) at long‐term follow‐up. Methods Thirty‐one knees in 29 patients (20.4 ± 5.7 years) were treated for symptomatic unfixable OCD lesions (2.6 ± 1.1 cm 2 ) and prospectively evaluated at 2, 5, and 12 years (average, minimum 10 years). Patients were evaluated over time with IKDC subjective score, EQ‐VAS, and Tegner scores. Failures were also documented. At the final follow‐up, MRI evaluation was performed in 14 knees with the MOCART 2.0 score. Results Beside 4 early failures, an overall clinical improvement was documented: the IKDC subjective score improved from 39.9 ± 16.8 to 82.1 ± 17.0 and 84.8 ± 17.2 at 2 and 5 years, respectively ( p < 0.0005), and remained stable for up to 12 years (85.0 ± 20.2). EQ‐VAS and Tegner scores presented similar trends, but patients did not reach their original activity level. Worse results were obtained for lesions bigger than 4 cm 2 . At MRI evaluation, subchondral bone abnormalities were detected in over 85% of knees at long‐term follow‐up. Conclusions Arthroscopic bone grafting followed by MACT for unfixable knee OCD can offer a promising and stable clinical outcome over time in lesions smaller than 4 cm 2 , with a low failure rate of 13%. Persistent subchondral alterations were documented at long‐term MRI evaluation, suggesting the limits of this approach to regenerate the osteochondral unit in patients affected by knee OCD. Level of evidence IV.