Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Meng , ZHANG Zheng , YAN Lixiang ,  LIU Danping

Department of Orthopedic Surgery and Sports Medicine, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou Liaoning, 121001, P.R.China;

Corresponding author：

LIU Danping, Email: liudanping2009@sohu.com

Keywords：

Microfracture; osteochondral autologous transplantation; cartilage injury; knee; femoral condyle; arthroscopy

DOI：

10.7507/1002-1892.201907048

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Objective To explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation (OAT) in treatment of large area (4-6 cm²) cartilage injury of the femoral condyle of knee.Methods Between March 2016 and June 2017, 22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT. There were 16 males and 6 females with an average age of 22-60 years (mean, 38.6 years). The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases. The disease duration was 1-6 months (mean, 3.4 months). There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries. The area of cartilage defect was 4-6 cm² (mean, 4.98 cm²). According to the International Cartilage Repair Society (ICRS) classification, 9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ. Eighteen cases were combined with meniscus injuries. Preoperative visual analogue scale (VAS) score was 6.36±1.25 and Lysholm score was 36.00±7.77.Results All incisions healed by first intention. All patients were followed up 2-3 years with an average of 2.3 years. At 2 years after operation, the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21, which were significantly improved when compared with those before operation (t=16.595, P=0.000; t=21.895, P=0.000). At 2 years after operation, MRI showed that the cartilage defect was repaired well.Conclusion Arthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee, and the good early effectiveness can be obtained.

Citation： SONG Meng, ZHANG Zheng, YAN Lixiang, LIU Danping. Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 330-334. doi: 10.7507/1002-1892.201907048 Copy

1.	Vijayan S, Bentley G, Briggs T, et al. Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques. Indian J Orthop, 2010, 44(3): 238-245.
2.	Gottardi R, Hansen U, Raiteri R, et al. Supramolecular oganization of collagen fibrils in healthy and osteoarthritic human knee and hip joint cartilage. PLoS One, 2016, 11(10): e0163552.
3.	Żylińska B, Silmanowicz P, Sobczyńska-Rak A, et al. Treatment of articular cartilage defects: focus on tissue engineering. In Vivo, 2018, 32(6): 1289-1300.
4.	van den Borne MP, Raijmakers NJ, Vanlauwe J, et al. International Cartilage Repair Society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture. Osteoarthritis Cartilage, 2007, 15(12): 1397-1402.
5.	Salzmann GM, Niemeyer P, Hochrein A, et al. Articular cartilage repair of the knee in children and adolescents. Orthop J Sports Med, 2018, 6(3): 2325967118760190.
6.	Bhosale AM, Richardson JB. Articular cartilage: structure, injuries and review of management. Br Med Bull, 2008, 87(1): 77-95.
7.	Farr J, Cole B, Dhawan A, et al. Clinical cartilage restoration: evolution and overview. Clin Orthop Res, 2011, 469(10): 2696-2705.
8.	Orth P, Duffner J, Zurakowski D, et al. Small-diameter awls improve articular cartilage repair after microfracture treatment in a translational animal model. Am J Sports Med, 2016, 44(1): 209-219.
9.	Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol, 2013, 9(10): 584-594.
10.	Goyal D, Keyhani S, Goyal A, et al. Evidence-based status of osteochondral cylinder transfer techniques: a systematic review of levelⅠandⅡstudies. Arthroscopy, 2014, 30(4): 497-505.
11.	Hingelbaum S, Best R, Huth J, et al. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2388-2395.
12.	DiBartola AC, Everhart JS, Magnussen RA, et al. Correlation between histological outcome and surgical cartilage repair technique in the knee: A meta-analysis. Knee, 2016, 23(3): 344-349.
13.	de Queiroz AAB, Debieux P, Amaro J, et al. Hydrogel implant is as effective as osteochondral autologous transplantation for treating focal cartilage knee injury in 24 months. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2934-2941.
14.	Moradi B, Schönit E, Nierhoff C, et al. First-generation autologous chondrocyte implantation in patients with cartilage defects of the knee: 7 to 14 years’ clinical and magnetic resonance imaging follow-up evaluation. Arthroscopy, 2012, 28(12): 1851-1861.
15.	Medvedeva EV, Grebenik EA, Gornostaeva SN, et al. Repair of damaged articular cartilage: current approaches and future directions. Int J Mol Sci, 2018, 19(8): 2366.
16.	Rosa D, Di Donato SL, Balato G, et al. How to manage a failed cartilage repair: a systematic literature review. Joints, 2017, 5(2): 93-106.
17.	Mistry H, Connock M, Pink J, et al. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess, 2017, 21(6): 1-294.
18.	Kato Y, Chavez J, Yamada S, et al. A large knee osteochondral lesion treated using a combination of osteochondral autograft transfer and second-generation autologous chondrocyte implantation: A case report. Regen Ther, 2018, 10: 10-16.
19.	Chapman CR, Casey KL, Dubner R, et al. Pain measurement: an overview. Pain, 1985, 22(1): 1-31.
20.	Kocher MS, Steadman JR, Briggs KK, et al. Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg (Am), 2004, 86(6): 1139-1145.
21.	Camp CL, Stuart MJ, Krych AJ. Current concepts of articular cartilage restoration techniques in the knee. Sports Health, 2014, 6(3): 265-273.
22.	Pascual-Garrido C, Daley E, Verma NN, et al. A comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthroscopy, 2017, 33(2): 364-373.
23.	Niemeyer P, Albrecht D, Andereya S, et al. Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU). Knee, 2016, 23(3): 426-435.

1. Vijayan S, Bentley G, Briggs T, et al. Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques. Indian J Orthop, 2010, 44(3): 238-245.
2. Gottardi R, Hansen U, Raiteri R, et al. Supramolecular oganization of collagen fibrils in healthy and osteoarthritic human knee and hip joint cartilage. PLoS One, 2016, 11(10): e0163552.
3. Żylińska B, Silmanowicz P, Sobczyńska-Rak A, et al. Treatment of articular cartilage defects: focus on tissue engineering. In Vivo, 2018, 32(6): 1289-1300.
4. van den Borne MP, Raijmakers NJ, Vanlauwe J, et al. International Cartilage Repair Society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture. Osteoarthritis Cartilage, 2007, 15(12): 1397-1402.
5. Salzmann GM, Niemeyer P, Hochrein A, et al. Articular cartilage repair of the knee in children and adolescents. Orthop J Sports Med, 2018, 6(3): 2325967118760190.
6. Bhosale AM, Richardson JB. Articular cartilage: structure, injuries and review of management. Br Med Bull, 2008, 87(1): 77-95.
7. Farr J, Cole B, Dhawan A, et al. Clinical cartilage restoration: evolution and overview. Clin Orthop Res, 2011, 469(10): 2696-2705.
8. Orth P, Duffner J, Zurakowski D, et al. Small-diameter awls improve articular cartilage repair after microfracture treatment in a translational animal model. Am J Sports Med, 2016, 44(1): 209-219.
9. Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol, 2013, 9(10): 584-594.
10. Goyal D, Keyhani S, Goyal A, et al. Evidence-based status of osteochondral cylinder transfer techniques: a systematic review of levelⅠandⅡstudies. Arthroscopy, 2014, 30(4): 497-505.
11. Hingelbaum S, Best R, Huth J, et al. The TT-TG Index: a new knee size adjusted measure method to determine the TT-TG distance. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2388-2395.
12. DiBartola AC, Everhart JS, Magnussen RA, et al. Correlation between histological outcome and surgical cartilage repair technique in the knee: A meta-analysis. Knee, 2016, 23(3): 344-349.
13. de Queiroz AAB, Debieux P, Amaro J, et al. Hydrogel implant is as effective as osteochondral autologous transplantation for treating focal cartilage knee injury in 24 months. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2934-2941.
14. Moradi B, Schönit E, Nierhoff C, et al. First-generation autologous chondrocyte implantation in patients with cartilage defects of the knee: 7 to 14 years’ clinical and magnetic resonance imaging follow-up evaluation. Arthroscopy, 2012, 28(12): 1851-1861.
15. Medvedeva EV, Grebenik EA, Gornostaeva SN, et al. Repair of damaged articular cartilage: current approaches and future directions. Int J Mol Sci, 2018, 19(8): 2366.
16. Rosa D, Di Donato SL, Balato G, et al. How to manage a failed cartilage repair: a systematic literature review. Joints, 2017, 5(2): 93-106.
17. Mistry H, Connock M, Pink J, et al. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess, 2017, 21(6): 1-294.
18. Kato Y, Chavez J, Yamada S, et al. A large knee osteochondral lesion treated using a combination of osteochondral autograft transfer and second-generation autologous chondrocyte implantation: A case report. Regen Ther, 2018, 10: 10-16.
19. Chapman CR, Casey KL, Dubner R, et al. Pain measurement: an overview. Pain, 1985, 22(1): 1-31.
20. Kocher MS, Steadman JR, Briggs KK, et al. Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg (Am), 2004, 86(6): 1139-1145.
21. Camp CL, Stuart MJ, Krych AJ. Current concepts of articular cartilage restoration techniques in the knee. Sports Health, 2014, 6(3): 265-273.
22. Pascual-Garrido C, Daley E, Verma NN, et al. A comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthroscopy, 2017, 33(2): 364-373.
23. Niemeyer P, Albrecht D, Andereya S, et al. Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU). Knee, 2016, 23(3): 426-435.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee

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