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

Research output: Contribution to journalArticlepeer-review

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 cm2) 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 cm2. 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 cm2, 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.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalKnee Surgery, Sports Traumatology, Arthroscopy
DOIs
Publication statusE-pub ahead of print - Aug 18 2020

Keywords

  • Cartilage
  • Knee
  • MACT
  • Osteochondritis dissecans
  • Scaffold
  • Subchondral

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