Ten-Year Follow-up of a Prospective,Randomized Clinical Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondral Defects in the Knee Joint of Athletes

Abstract

Background:

Various techniques have proven to be effective for treating articular cartilage defect (ACD) and osteochondral defect (OCD) of the knee joint, but knowledge regarding which method is best still remains uncertain.

Purpose:

To evaluate and compare the outcomes of mosaic-type osteochondral autologous transplantation (OAT) and microfracture (MF) procedures for the treatment of articular cartilage defects of the knee joint in young active athletes. This article represents an update of the clinical results at 10 years.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Between 1998 and 2002, a total of 60 athletes with a mean age of 24.3 years (range, 15-40 years) and with a symptomatic ACD or OCD in the knee were randomized to undergo either OAT or MF. Patients were then evaluated postoperatively using the International Cartilage Repair Society (ICRS) score, Tegner activity score, radiographs, and magnetic resonance imaging. The mean follow-up time was 10.4 years (range, 9-11 years).

Results:

Three to 10 years after the OAT and MF procedures, patients had lower ICRS and Tegner scores (P < .05), but both groups still had significant clinical improvement over presurgery scores according to ICRS scores at 10-year follow-up. Statistically significantly better results were detected in patients in the OAT group compared with those in the MF group at 10 years (P < .005). At 10-year follow-up, there were 15 failures (26%), including 4 failures (14%) of the OAT and 11 failures (38%) of MF treatment (P < .05). Seven patients (25%) from the OAT group and 14 patients (48%) from the MF group had radiographic evidence of Kellgren-Lawrence grade I osteoarthritis at 10 years, but these differences were not significant (P = .083) or related to the clinical results. The ICRS and Tegner scores of younger athletes (<25 years at the time of primary surgery) remained significantly higher after 10 years compared with older patients (P < .05); 15 of 20 patients (75%) in the OAT group and 8 of 22 patients (37%) in the MF group maintained the same physical activity level.

Conclusion:

The OAT technique for ACD or OCD repair in the athletic population allows for a higher rate of return to and maintenance of sports at the preinjury level compared with MF.

Keywords

articular cartilage osteochondral autologous transplantation microfracture athletes

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References

Berlet

Mascia

Miniaci

. Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). Arthroscopy. 1999;15(3):312–316.

Blevins

Steadman

Rodrigo

Silliman

. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics. 1998;21:761–767.

Brittberg

Winalski

. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003;85(suppl 2):58–69.

Cerynik

Lewullis

Joves

Palmer

Tom

. Outcomes of microfracture in professional basketball players. Knee Surg Sports Traumatol Arthrosc. 2009;17:1135–1139.

Gobbi

Nunag

Malinowski

. Treatment of chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc. 2004;13:213–221.

Gudas

. Clinical results after revision articular cartilage damage surgeries [in Lithuanian]. Medicina. 2004;40:315–319.

Gudas

Kalesinskas

Kimtys

. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy. 2005;21:1066–1075.

Gudas

Kalesinskas

Kunigiskis

. Long term results of osteochondritis dissecans defect excision in the knee joint. Medicina. 2002;38:284–288.

Gudas

Stankevicius

Monastyreckiene

Pranys

Kalesinkas

. Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes. Knee Surg Traumatol Arthrosc. 2006;14:834–842.

10.

Horas

Pelinkovic

Herr

Aigner

Schnettler

. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint: a prospective, comparative trial. J Bone Joint Surg Am. 2003;85:185–192.

11.

Kessler

Guenther

Puhl

. Scoring prevalence and severity in gonarthritis: the suitability of the Kellgren & Lawrence scale. Clin Rheumatol. 1998;17(3):205–209.

12.

Kish

Modis

Hangody

. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete: rationale, indications, technique, and results. Clin Sports Med. 1999;18:45–66.

13.

Knutsen

Drogset

Engebretsen

. A randomized trial comparing autologous chondrocyte implantation with microfracture: findings at five years. J Bone Joint Surg Am. 2007;89:2105–2112.

14.

Kon

Gobbi

Filardo

Delcogliano

Zaffagini

Marcacci

. Arthroscopic second(generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 2009;37:33–41.

15.

Maletius

Messner

. The long-term prognosis for severe damage to the weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthop Scand. 1996;67:165–168.

16.

Marcacci

Kon

Delcogliano

Filardo

Busacca

Zaffagini

. Arthroscopic autologous osteochondral grafting for cartilage defects of the knee: prospective study results at a minimum 7-year follow-up. Am J Sports Med. 2007;35(12):2014–2021.

17.

Marcacci

Kon

Zaffagini

. Multiple osteochondral arthroscopic grafting (mosaicplasty) for cartilage defects of the knee: prospective study results at 2-year follow-up. Arthroscopy. 2005;21:462–470.

18.

Marlovits

Singer

Zeller

Mandl

Haller

Trattnig

. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: Determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol. 2006;57:16–23.

19.

Mithoefer

Hambly

Della Villa

Silvers

Mandelbaum

. Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med. 2009;37(suppl 1):167S–176S.

20.

Mithofer

Minas

Peterson

Yeon

Micheli

. Functional outcome of articular cartilage repair in adolescent athletes. Am J Sports Med. 2005;33:1147–1153.

21.

Mithofer

Peterson

Mandelbaum

Minas

. Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition. Am J Sports Med. 2005;33:1639–1646.

22.

Mithoefer

Steadman

. Microfracture in football (soccer) players: a case series of professional athletes and systematic review. Cartilage. 2012;3(suppl):18S–24S.

23.

Mithoefer

Williams

Warren

Wickiewicz

Marx

. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med. 2006;34:1413–1418.

24.

Namdari

Baldwin

Anakwenze

Park

Huffman

Sennett

. Results and performance after microfracture in national association basketball. Am J Sports Med. 2009;37:943–948.

25.

Pánics

Hangody

Baló

Vásárhelyi

Gál

Hangody

. Osteochondral autograft and mosaicplasty in the football (soccer) athlete. Cartilage. 2012;3(suppl):25S–30S.

26.

Riyami

Rolf

. Evaluation of microfracture of traumatic chondral injuries to the knee in professional football and rugby players. J Orthop Surg Res. 2009;4:13–22.

27.

Saris

Vanlauwe

Victor

. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med. 2009;37(suppl 1):10S–19S.

28.

Steadman

Briggs

Rodrigo

Kocher

Gill

Rodkey

. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19:477–484.

29.

Steadman

Miller

Karas

Schlegel

Briggs

Hawkins

. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16:83–86.