Osteochondral Autologous Transplantation of the Knee in Adolescents: Mid-Term Functional and Radiographic Outcomes
DOI:
https://doi.org/10.63403/re.v33i1.456Keywords:
Osteochondral autologous transplantation, Knee, Adolescents, Osteochondritis dissecans, OutcomesAbstract
Introduction: osteochondral autologous transplantation is a surgical technique for treating osteochondral defects. Evidence regarding its outcomes in pediatric and adolescent patients is limited.
Objectives: The objective of the present study was to evaluate the clinical, radiographic, and magnetic resonance imaging (MRI) outcomes of a consecutive series of patients under 18 years of age treated with autologous osteochondral transplantation.
Materials and methods: data from 30 patients (33 knees) were retrospectively analyzed. Surgical indications, perioperative complications, and outcomes were evaluated: clinical scores included Pedi-IKDC, Lysholm, return to sport, and knee pain; imaging included MRI to determine osteochondral graft integration and radiography to evaluate osteoarthritis (Kellgren-Lawrence).
Results: the mean age was 15.3 ± 2.1 years. The most frequent location was the medial femoral condyle. Between one to three osteochondral grafts were transplanted (average diameter of 8.5 mm). In 17 knees, grafts were used to fill cartilage defects (CD), while in 16 knees, they were used for hybrid internal fixation (HIF) of unstable osteochondritis dissecans. The mean lesion size was 132 mm² for CD and 404.1 mm² for HIF (p <0.0001). The mean follow-up was 20.5 months (range 6-80 months). Return to sport was achieved at a mean of 7.8 ± 2.6 months. The mean MOCART score was 85.2 ± 6.6, no significant differences were found base on lesion location (p = 0.54). Thirty-one knees had a KL grade 1, and two presented grade 2. At the last follow-up, 27 patients were asymptomatic and 3 reported occasional discomfort.
Conclusion: Autologous osteochondral transplantation in patients under 18 years of age was associated with a significant improvement in symptoms and adequate graft integration in all cases.
Level of Evidence: IV. Retrospective cohort study.
Downloads
References
Valtanen RS, Arshi A, Kelley BV, Fabricant PD, Jones KJ. Articular cartilage repair of the pediatric and adolescent knee with regard to minimal clinically important difference: a systematic review. Cartilage. 2020;11(1):9-18. doi: https://www.doi.org/10.1177/1947603518783503. DOI: https://doi.org/10.1177/1947603518783503
Abdullah SB, Iyer RS, Shet NS. Pediatric osteochondral lesions. Semin Musculoskelet Radiol. 2018;22(1):57-65. doi: https://www.doi.org/10.1055/s-0037-1608006. DOI: https://doi.org/10.1055/s-0037-1608006
Buckwalter JA, Mankin HJ. Articular cartilage: tissue design and chondrocyte-matrix interactions. Instr Course Lect. 1998;47:477-86.
Bedi A, Feeley BT, Williams RJ. Management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92(4):994-1009. doi: https://www.doi.org/10.2106/JBJS.I.00895. DOI: https://doi.org/10.2106/JBJS.I.00895
Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133(5):321-328. doi: https://www.doi.org/10.7326/0003-4819-133-5-200009050-00007 DOI: https://doi.org/10.7326/0003-4819-133-5-200009050-00007
Lahav A, Burks RT, Greis PE, Chapman AW, Ford GM, Fink BP. Clinical outcomes following osteochondral autologous transplantation (OATS). J Knee Surg. 2006 Jul;19(3):169-173. doi: https://www.doi.org/10.1055/s-0030-1248101. DOI: https://doi.org/10.1055/s-0030-1248101
Hubbard MJ. Articular debridement versus washout for degeneration of the medial femoral condyle. A five-year study. J Bone Joint Surg Br. 1996;78(2):217-219. DOI: https://doi.org/10.1302/0301-620X.78B2.0780217
Krüger T, Wohlrab D, Birke A, Hein W. Results of arthroscopic joint debridement in different stages of chondromalacia of the knee joint. Arch Orthop Trauma Surg. 2000;120(5-6):338-342. doi: https://www.doi.org/10.1007/s004020050478. DOI: https://doi.org/10.1007/s004020050478
Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19(5):477-484. doi: https://www.doi.org/10.1053/jars.2003.50112. DOI: https://doi.org/10.1053/jars.2003.50112
Cain EL, Clancy WG. Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med. 2001;20(2):321-342. doi: https://www.doi.org/10.1016/s0278-5919(05)70309-4. DOI: https://doi.org/10.1016/S0278-5919(05)70309-4
Johnson LL. Arthroscopic abrasion arthroplasty: a review. Clin Orthop Relat Res. 2001;(391 Suppl):S306-S317. DOI: https://doi.org/10.1097/00003086-200110001-00028
Nehrer S, Spector M, Minas T. Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop Relat Res. 1999;(365):149-162. doi: https://www.doi.org/0.1097/00003086-199908000-00020. DOI: https://doi.org/10.1097/00003086-199908000-00020
Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;(391 Suppl):S362-S369. doi:https://www.doi.org/10.1097/00003086-200110001-00033. DOI: https://doi.org/10.1097/00003086-200110001-00033
Henderson I, Tuy B, Oakes B. Reoperation after autologous chondrocyte implantation. Indications and findings. J Bone Joint Surg Br. 2004;86(2):205-211. doi: https://www.doi.org/10.1302/0301-620x.86b2.14324. DOI: https://doi.org/10.1302/0301-620X.86B2.14324
O'Driscoll SW, Fitzsimmons JS. The role of periosteum in cartilage repair. Clin Orthop Relat Res. 2001 Oct;(391 Suppl):S190-207. doi: https://www.doi.org/10.1097/00003086-200110001-00019. DOI: https://doi.org/10.1097/00003086-200110001-00019
Brittberg M, Tallheden T, Sjögren-Jansson B, Lindahl A, Peterson L. Autologous chondrocytes used for articular cartilage repair: an update. Clin Orthop Relat Res. 2001;(391 Suppl):S337-S348. doi: https://www.doi.org/10.1097/00003086-200110001-00031. DOI: https://doi.org/10.1097/00003086-200110001-00031
Jungmann PM, Gersing AS, Baumann F, et al. Cartilage repair surgery prevents progression of knee degeneration. Knee Surg Sports Traumatol Arthrosc. 2019;27(9):3001-3013. doi: https://www.doi.org/10.1007/s00167-018-5321-8 DOI: https://doi.org/10.1007/s00167-018-5321-8
Lu V, Wong TM. Do reconstructive techniques for osteochondritis dissecans of the skeletally mature knee work? A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2024;32(8):1969-1991. doi: https://www.doi.org/10.1002/ksa.12214. DOI: https://doi.org/10.1002/ksa.12214
Rowland R, Colello M, Wyland DJ. Osteochondral autograft transfer procedure: arthroscopic technique and technical pearls. Arthrosc Tech. 2019;8(7):e713-e719. doi: https://doi.org/10.1016/j.eats.2019.03.006. DOI: https://doi.org/10.1016/j.eats.2019.03.006
Kocher MS, Smith JT, Iversen MD, et al. Reliability, validity, and responsiveness of a modified International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC) in children with knee disorders. Am J Sports Med. 2011;39(5):933-939. doi: https://www.doi.org/10.1177/0363546510383002. DOI: https://doi.org/10.1177/0363546510383002
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150-154. doi: https://www.doi.org/10.1177/036354658201000306. DOI: https://doi.org/10.1177/036354658201000306
Schreiner MM, Raudner M, Marlovits S, et al. The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas. Cartilage. 2021;13(1_suppl):571S-587S. doi: https://www.doi.org/10.1177/1947603519865308. DOI: https://doi.org/10.1177/1947603519865308
Kellgren J H y Lawrence JS. (1957). Radiological assessment of osteo-arthrosis. Annals of the Rheumatic Diseases. 16(4):494–502. doi: https://www.doi.org/10.1136/ard.16.4.494 DOI: https://doi.org/10.1136/ard.16.4.494
Ali Yousef MA, Rosenfeld S. Acute traumatic rupture of the patellar tendon in the pediatric population: Case series and review of the literature. Injury. 2017;48(11):2515-2521. doi: https://doi.org/10.1016/j.injury.2017.08.069. DOI: https://doi.org/10.1016/j.injury.2017.08.069
Gudas R, Simonaityte R, Cekanauskas E, Tamosiūnas R. A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop. 2009;29(7):741-748. doi:https://doi.org/10.1097/BPO.0b013e3181b8f6c7. DOI: https://doi.org/10.1097/BPO.0b013e3181b8f6c7
Sasaki K, Matsumoto T, Matsushita T, et al. Osteochondral autograft transplantation for juvenile osteochondritis dissecans of the knee: a series of twelve cases. Int Orthop. 2012;36(11):2243-2248. doi:https://doi.org/10.1007/s00264-012-1648-9. DOI: https://doi.org/10.1007/s00264-012-1648-9
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Nicolas Fernando Rabello, Julio Javier Masquijo, Milca Sanchez Ortiz
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This work is published under a Creative Commons Attribution–NonCommercial–ShareAlike 4.0 International License (CC BY-NC-SA 4.0). The authors retain the copyright.
