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Successful Graft Treatment for Full-Thickness Cartilage Tears

Knee injuries can be very complex to treat. This is especially true when there is damage to the surface of the bone. The layer of cartilage in contact with the bone is torn away from the bone. Sometimes even a piece of bone pulls away with it. This is called a full-thickness lesion.

Surgeons are trying to find the best way to treat this type of injury. The cartilage doesn't have its own blood supply. For this reason, healing is often slow or doesn't happen at all even with intervention.

In this study, orthopedic surgeons from Italy report on the use of autologous osteochondral grafts to treat this problem. Autologous means the patient uses tissue from some other part of his or her own body. Osteochondral refers to the cartilage just above the bone that lines the joint surface.

The procedure is described in detail. First the damaged area was prepared for the graft. All loose or torn tissue was removed. The remaining surface was smoothed down. Tiny holes were dilled in the chondral surface. Osteochondral grafts were harvested from the donor site.

The plugs of graft bone were placed inside the holes. Once again, the surface is smoothed over. Each patient's defect was completely repaired.
Everyone was examined every year for seven years. The mid- to long-term results were very good for three-fourths of the patients.

MRIs were used to look at how well the graft took hold in the host bone. About 60 per cent of the patients still had a successful cartilage graft after seven years. There was one down side in the final outcomes. Some of the patients had to reduce or limit their level of sports activity.

The authors reported that smaller lesions requiring fewer osteochondral plugs had the best results. These patients were more likely to return to their previous level of sports activity. Using larger plugs decreased the amount of fibrous tissue filling and subsequent problems.

References: Maurilio Marcacci, MD, et al. Arthroscopic Autologous Osteochondral Grafting for Cartilage Defects of the Knee. In The American Journal of Sports Medicine. December 2007. Vol. 35. No. 12. Pp. 2014-2021.

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